Healthcare Provider Details

I. General information

NPI: 1205778719
Provider Name (Legal Business Name): CALM HARBOR BEHAVIORAL HEALTH SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/06/2026
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

813 S POKEGAMA AVE
GRAND RAPIDS MN
55744-3934
US

IV. Provider business mailing address

10 EAST ST
HONEOYE FALLS NY
14472-1202
US

V. Phone/Fax

Practice location:
  • Phone: 651-272-2271
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: KRISTINA NICOLE JACOBSEN
Title or Position: OWNER
Credential: APRN, PMHNP-BC
Phone: 651-343-5936