Provider Demographics
NPI:1134943962
Name:TJERNLUND, JACOB ROSS (LMFT)
Entity type:Individual
Prefix:MR
First Name:JACOB
Middle Name:ROSS
Last Name:TJERNLUND
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:983 CARLTON DR
Mailing Address - Street 2:
Mailing Address - City:SHOREVIEW
Mailing Address - State:MN
Mailing Address - Zip Code:55126-8130
Mailing Address - Country:US
Mailing Address - Phone:651-295-1223
Mailing Address - Fax:
Practice Address - Street 1:1619 DAYTON AVE STE 309
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55104-6276
Practice Address - Country:US
Practice Address - Phone:612-746-2975
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-08
Last Update Date:2024-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4496106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist