MEDICARE: CALM HARBOR BEHAVIORAL HEALTH SERVICES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner

General Provider Information

NPI Number	:	1205778719
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CALM HARBOR BEHAVIORAL HEALTH SERVICES

Provider Business Mailing Address
First Line	:	10 EAST ST
Second Line	:
City	:	HONEOYE FALLS
State	:	NY
Zip	:	14472-1202
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	618 ADAMS ST NE
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55413-2144
Country	:	US
Telephone Number	:	651-272-2271
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	KRISTINA NICOLE JACOBSEN
Credential	:	APRN, PMHNP-BC
Telephone Number	:	651-343-5936

Provider Enumeration Date	:	04/06/2026
Last Update Date	:	04/06/2026

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