MEDICARE: JARED LEE LMFT

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	4626	MN

General Provider Information

NPI Number	:	1306397591
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JARED LEE LMFT

Provider Business Mailing Address
First Line	:	1442 SIMPSON ST
Second Line	:
City	:	SAINT PAUL
State	:	MN
Zip	:	55108-2341
Country	:	US
Telephone Number	:	701-212-3999
Fax Number	:

Provider Business Practice Location Address
First Line	:	992 INWOOD AVE N
Second Line	:
City	:	SAINT PAUL
State	:	MN
Zip	:	55128-6625
Country	:	US
Telephone Number	:	612-440-7817
Fax Number	:

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

Provider Enumeration Date	:	10/22/2016
Last Update Date	:	07/02/2024

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