Provider Demographics
NPI:1518113273
Name:HUNTER, JAY RUSSELL (MA, LMFT)
Entity Type:Individual
Prefix:MR
First Name:JAY
Middle Name:RUSSELL
Last Name:HUNTER
Suffix:
Gender:M
Credentials:MA, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2046 ST. CLAIR AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55105-2124
Mailing Address - Country:US
Mailing Address - Phone:651-269-0485
Mailing Address - Fax:
Practice Address - Street 1:2046 ST. CLAIR AVE
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55105-2124
Practice Address - Country:US
Practice Address - Phone:651-269-0485
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-13
Last Update Date:2012-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1605106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist