Provider Demographics
NPI:1689975963
Name:VERBOUT, JESSICA LYNETTE (MA, LMFT)
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:LYNETTE
Last Name:VERBOUT
Suffix:
Gender:F
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 1:5821 CEDAR LAKE RD S
Mailing Address - Street 2:SUITE 11
Mailing Address - City:ST LOUIS PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55416-1487
Mailing Address - Country:US
Mailing Address - Phone:612-229-9790
Mailing Address - Fax:
Practice Address - Street 1:5821 CEDAR LAKE RD S
Practice Address - Street 2:SUITE 11
Practice Address - City:ST LOUIS PARK
Practice Address - State:MN
Practice Address - Zip Code:55416-1487
Practice Address - Country:US
Practice Address - Phone:612-229-9790
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-03
Last Update Date:2011-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist