Provider Demographics
NPI:1639672694
Name:SPEHAR, JACOB LOUIS (MA, LPCC, LADC)
Entity Type:Individual
Prefix:
First Name:JACOB
Middle Name:LOUIS
Last Name:SPEHAR
Suffix:
Gender:M
Credentials:MA, LPCC, LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5824 213TH ST N
Mailing Address - Street 2:
Mailing Address - City:FOREST LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:55025-9745
Mailing Address - Country:US
Mailing Address - Phone:651-226-7906
Mailing Address - Fax:
Practice Address - Street 1:155 LAKE ST S STE 102
Practice Address - Street 2:
Practice Address - City:FOREST LAKE
Practice Address - State:MN
Practice Address - Zip Code:55025-2604
Practice Address - Country:US
Practice Address - Phone:651-461-1438
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-15
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNCC01722101YM0800X
MN303864101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)