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General NPI Number Information
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NPI Number | 1235736786
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Entity Type | Individual
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Provider Name | CATHERINE ANN JAKSHA LADC, LPCC
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Gender | Female
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Dates
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Enumeration Date | 10/07/2020
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Last Update Date | 02/18/2021
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Provider Practice Location Address
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Address Line | 1856 BEAM AVE STE 200
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City | MAPLEWOOD
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State | MN
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Zip | 55109-1162
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Country | US
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Telephone | 612-269-6784
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Fax |
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Provider Business Mailing Address
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Address Line | 1180 CUSHING CIR APT 217
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City | SAINT PAUL
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State | MN
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Zip | 55108-5016
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Country | US
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Telephone | 612-269-6784
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 304962
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 2601
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License Number State | MN
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