Healthcare Provider Details

I. General information

NPI: 1235282732
Provider Name (Legal Business Name): FRANCIS M. JACOBSON L.P.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/19/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

126 EAST ALCOTT AVENUE LAKELAND MENTAL HEALTH CENTER
FERGUS FALLS MN
56537-2999
US

IV. Provider business mailing address

1311 E MINNESOTA AVE
FERGUS FALLS MN
56537-1763
US

V. Phone/Fax

Practice location:
  • Phone: 218-736-6987
  • Fax:
Mailing address:
  • Phone: 218-739-4797
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License NumberLP2936
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: