Healthcare Provider Details

I. General information

NPI: 1548828684
Provider Name (Legal Business Name): JESSICA ROBIN NELSON-MITCHELL LAMFT, LADC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2019
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7600 PARKLAWN AVE STE 380
EDINA MN
55435-5156
US

IV. Provider business mailing address

7600 PARKLAWN AVE STE 380
EDINA MN
55435-5156
US

V. Phone/Fax

Practice location:
  • Phone: 612-203-2961
  • Fax:
Mailing address:
  • Phone: 612-203-2961
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number303791
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number4782
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: