Provider Demographics
NPI:1225880388
Name:PARK, JIN (LPCC)
Entity Type:Individual
Prefix:MRS
First Name:JIN
Middle Name:
Last Name:PARK
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:240 CHICAGO AVE APT 301
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55415-2232
Mailing Address - Country:US
Mailing Address - Phone:718-986-8096
Mailing Address - Fax:
Practice Address - Street 1:2984 RICE ST
Practice Address - Street 2:
Practice Address - City:LITTLE CANADA
Practice Address - State:MN
Practice Address - Zip Code:55113-2230
Practice Address - Country:US
Practice Address - Phone:651-968-4974
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-03
Last Update Date:2024-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4343101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional