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General NPI Number Information
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NPI Number | 1619771433
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Entity Type | Individual
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Provider Name | DAVID R JOUBERT LADC
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Gender | Male
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Dates
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Enumeration Date | 04/02/2025
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Last Update Date | 04/02/2025
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Provider Practice Location Address
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Address Line | 2266 2ND ST N STE 2
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City | NORTH ST PAUL
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State | MN
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Zip | 55109-2914
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Country | US
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Telephone | 651-330-6642
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Fax | 651-342-8806
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Provider Business Mailing Address
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Address Line | 1033 GALTIER ST UNIT 2
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City | SAINT PAUL
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State | MN
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Zip | 55117-5153
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Country | US
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Telephone | 612-272-4374
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Fax | 651-342-8806
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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 | 305244
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License Number State | MN
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