Provider Demographics
NPI:1548708464
Name:UTRZAN, DAMIR S (PHD, LMFT, DAAETS)
Entity type:Individual
Prefix:DR
First Name:DAMIR
Middle Name:S
Last Name:UTRZAN
Suffix:
Gender:M
Credentials:PHD, LMFT, DAAETS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:971 SIBLEY MEMORIAL HWY STE NO250
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55118-2324
Mailing Address - Country:US
Mailing Address - Phone:612-900-7021
Mailing Address - Fax:
Practice Address - Street 1:1295 NORTHLAND DR STE 270
Practice Address - Street 2:
Practice Address - City:MENDOTA HEIGHTS
Practice Address - State:MN
Practice Address - Zip Code:55120-1373
Practice Address - Country:US
Practice Address - Phone:612-900-7021
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-11
Last Update Date:2024-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2039-124106H00000X
MN3322106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist