Provider Demographics
NPI:1245863018
Name:JBM INDIVIDUAL & FAMILY COUNSELING LLC
Entity type:Organization
Organization Name:JBM INDIVIDUAL & FAMILY COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TANYA
Authorized Official - Middle Name:L
Authorized Official - Last Name:EUBANKS
Authorized Official - Suffix:
Authorized Official - Credentials:LCC
Authorized Official - Phone:612-607-9794
Mailing Address - Street 1:9141 30TH AVE N
Mailing Address - Street 2:
Mailing Address - City:NEW HOPE
Mailing Address - State:MN
Mailing Address - Zip Code:55427-2301
Mailing Address - Country:US
Mailing Address - Phone:612-607-9794
Mailing Address - Fax:
Practice Address - Street 1:9141 30TH AVE N
Practice Address - Street 2:
Practice Address - City:NEW HOPE
Practice Address - State:MN
Practice Address - Zip Code:55427-2301
Practice Address - Country:US
Practice Address - Phone:612-607-9794
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-19
Last Update Date:2020-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health