Healthcare Provider Details

I. General information

NPI: 1164158382
Provider Name (Legal Business Name): HOLISTIC MENTAL HEALTH PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2022
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

252 MARIE AVE E STE D-1
WEST ST PAUL MN
55118-2013
US

IV. Provider business mailing address

252 MARIE AVE E STE D-1
WEST ST PAUL MN
55118-2013
US

V. Phone/Fax

Practice location:
  • Phone: 612-699-4629
  • Fax: 612-213-0601
Mailing address:
  • Phone: 612-699-4629
  • Fax: 612-213-0601

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: SARAH M JACOBS
Title or Position: APRN, CNP
Credential: APRN, CNP
Phone: 304-590-5779