Provider Demographics
NPI:1851805758
Name:SEABURG, JON KONRAD (LADC , LPCC)
Entity Type:Individual
Prefix:
First Name:JON
Middle Name:KONRAD
Last Name:SEABURG
Suffix:
Gender:M
Credentials:LADC , LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2430 NICOLLET AVE
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55404-3461
Mailing Address - Country:US
Mailing Address - Phone:612-871-7443
Mailing Address - Fax:612-871-0194
Practice Address - Street 1:2430 NICOLLET AVE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55404-3461
Practice Address - Country:US
Practice Address - Phone:612-871-7443
Practice Address - Fax:612-871-0194
Is Sole Proprietor?:No
Enumeration Date:2017-11-30
Last Update Date:2017-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNCC01283103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical