MEDICARE: MR. JAY PATRICK HUNT M.A.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	947	MN

General Provider Information

NPI Number	:	1124164850
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JAY PATRICK HUNT M.A.

Provider Business Mailing Address
First Line	:	4315 UPPER 145TH ST W
Second Line	:
City	:	ROSEMOUNT
State	:	MN
Zip	:	55068-4136
Country	:	US
Telephone Number	:	651-423-6563
Fax Number	:

Provider Business Practice Location Address
First Line	:	5833 PECAN ST # A2
Second Line	:
City	:	NORTH BRANCH
State	:	MN
Zip	:	55056-6689
Country	:	US
Telephone Number	:	651-237-0628
Fax Number	:	651-237-0631

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/29/2007
Last Update Date	:	07/09/2007

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