Healthcare Provider Details

I. General information

NPI: 1679729529
Provider Name (Legal Business Name): BETH DIANE JONES MA, LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2008
Last Update Date: 05/07/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1068 LAKE ST S STE 109
FOREST LAKE MN
55025-2633
US

IV. Provider business mailing address

1023 11TH AVE SE
FOREST LAKE MN
55025-1943
US

V. Phone/Fax

Practice location:
  • Phone: 612-247-9397
  • Fax:
Mailing address:
  • Phone: 612-247-9397
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number1754
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: