Provider Demographics
NPI:1396825162
Name:VAN BLARCUM, LYNN (LMFT)
Entity Type:Individual
Prefix:
First Name:LYNN
Middle Name:
Last Name:VAN BLARCUM
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4655 NICHOLS RD
Mailing Address - Street 2:STE 206
Mailing Address - City:EAGAN
Mailing Address - State:MN
Mailing Address - Zip Code:55122
Mailing Address - Country:US
Mailing Address - Phone:612-747-2402
Mailing Address - Fax:651-578-6702
Practice Address - Street 1:4655 NICOLS RD
Practice Address - Street 2:STE 206
Practice Address - City:EAGAN
Practice Address - State:MN
Practice Address - Zip Code:55122-3425
Practice Address - Country:US
Practice Address - Phone:612-747-2402
Practice Address - Fax:651-578-6702
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1426106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist