Provider Demographics
NPI:1659583318
Name:LAUBE, HERBERT HERMAN (PHD)
Entity Type:Individual
Prefix:
First Name:HERBERT
Middle Name:HERMAN
Last Name:LAUBE
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1660 S. HIGHWAY L00 PARKDALE PLAZA
Mailing Address - Street 2:SUITE # L42
Mailing Address - City:ST. LOUIS PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55416-3823
Mailing Address - Country:US
Mailing Address - Phone:952-544-5719
Mailing Address - Fax:952-544-5719
Practice Address - Street 1:L660 SOUTH HIGHWAY L00
Practice Address - Street 2:SUITE L42
Practice Address - City:ST. LOUIS PARK
Practice Address - State:MN
Practice Address - Zip Code:55416-3823
Practice Address - Country:US
Practice Address - Phone:952-544-5719
Practice Address - Fax:952-544-5719
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN0460106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist