Provider Demographics
NPI:1629305206
Name:HJELMBERG, TARA LYNN (LMFT)
Entity Type:Individual
Prefix:MRS
First Name:TARA
Middle Name:LYNN
Last Name:HJELMBERG
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 1:4886 HIGHWAY 61 N
Mailing Address - Street 2:SUITE L3
Mailing Address - City:WHITE BEAR LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:55110-2857
Mailing Address - Country:US
Mailing Address - Phone:651-270-1477
Mailing Address - Fax:877-452-0692
Practice Address - Street 1:4886 HIGHWAY 61 N
Practice Address - Street 2:SUITE L3
Practice Address - City:WHITE BEAR LAKE
Practice Address - State:MN
Practice Address - Zip Code:55110-2857
Practice Address - Country:US
Practice Address - Phone:651-270-1477
Practice Address - Fax:877-452-0692
Is Sole Proprietor?:No
Enumeration Date:2009-11-03
Last Update Date:2016-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1663106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist