Provider Demographics
NPI:1427055573
Name:HOBBS, JIMMY EARL (MA/LP)
Entity type:Individual
Prefix:MR
First Name:JIMMY
Middle Name:EARL
Last Name:HOBBS
Suffix:
Gender:M
Credentials:MA/LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29525 COUNTY 13
Mailing Address - Street 2:
Mailing Address - City:BURTRUM
Mailing Address - State:MN
Mailing Address - Zip Code:56318-4626
Mailing Address - Country:US
Mailing Address - Phone:320-732-3041
Mailing Address - Fax:320-732-3041
Practice Address - Street 1:29525 COUNTY 13
Practice Address - Street 2:
Practice Address - City:BURTRUM
Practice Address - State:MN
Practice Address - Zip Code:56318-4626
Practice Address - Country:US
Practice Address - Phone:320-732-3041
Practice Address - Fax:320-732-3041
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-05
Last Update Date:2023-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP3785103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN973454600Medicaid