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General NPI Number Information
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NPI Number | 1881007672
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Entity Type | Individual
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Provider Name | JOSEPH ROBERT JEFFERSON PSYD, LP, LMFT, CPRP
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Gender | Male
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Dates
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Enumeration Date | 06/09/2014
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Last Update Date | 06/21/2025
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Provider Practice Location Address
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Address Line | 4800 OLSON MEMORIAL HWY STE 202
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City | GOLDEN VALLEY
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State | MN
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Zip | 55422-5169
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Country | US
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Telephone | 507-474-6264
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Fax | 507-218-8553
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Provider Business Mailing Address
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Address Line | 1401 21ST ST STE R
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City | SACRAMENTO
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State | CA
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Zip | 95811-5226
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Country | US
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Telephone | 619-980-9549
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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 | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 35901
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License Number State | CA
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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 | 3198
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License Number State | MN
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Taxonomy #3
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 1031-124
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License Number State | WI
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