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General NPI Number Information
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NPI Number | 1801968094
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Entity Type | Individual
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Provider Name | JANE GALVIN BACON MA LP LMFT
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Gender | Female
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Dates
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Enumeration Date | 11/14/2006
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 1280 NORTH BIRCH LAKE BLVD WHITE BEAR LAKE AREA COMMUNITY COUNSELING CENTER
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City | WHITE BEAR LAKE
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State | MN
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Zip | 55110-6708
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Country | US
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Telephone | 651-429-8544
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Fax | 651-407-5301
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Provider Business Mailing Address
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Address Line | 1280 NORTH BIRCH LAKE BLVD WHITE BEAR LAKE AREA COMMUNITY COUNSELING CENTER
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City | WHITE BEAR LAKE
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State | MN
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Zip | 55110-6708
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Country | US
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Telephone | 651-429-8544
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Fax | 651-407-5301
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | LP2821
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 320
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License Number State | MN
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