Provider Demographics
NPI:1861871493
Name:JASIRA FAMILY COUNSELING
Entity type:Organization
Organization Name:JASIRA FAMILY COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JUNEAU
Authorized Official - Middle Name:RONNYE75
Authorized Official - Last Name:HILL ARMSTRONG
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:612-986-3836
Mailing Address - Street 1:131 CHRISTENSON CT NE
Mailing Address - Street 2:
Mailing Address - City:FRIDLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55432-4958
Mailing Address - Country:US
Mailing Address - Phone:612-986-3836
Mailing Address - Fax:763-561-1843
Practice Address - Street 1:131 CHRISTENSON CT NE
Practice Address - Street 2:
Practice Address - City:FRIDLEY
Practice Address - State:MN
Practice Address - Zip Code:55432-4958
Practice Address - Country:US
Practice Address - Phone:612-986-3836
Practice Address - Fax:763-561-1843
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-28
Last Update Date:2015-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN18096252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency