Provider Demographics
NPI:1700286903
Name:JARI WELLE, INC.
Entity Type:Organization
Organization Name:JARI WELLE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JARI
Authorized Official - Middle Name:
Authorized Official - Last Name:WELLE
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:651-245-3505
Mailing Address - Street 1:339 OAKWOOD DRIVE
Mailing Address - Street 2:
Mailing Address - City:SHOREVIEW
Mailing Address - State:MN
Mailing Address - Zip Code:55126
Mailing Address - Country:US
Mailing Address - Phone:651-245-3505
Mailing Address - Fax:651-846-6866
Practice Address - Street 1:1328 MCKAY DRIVE NE
Practice Address - Street 2:SUITE 100
Practice Address - City:HAM LAKE
Practice Address - State:MN
Practice Address - Zip Code:55304
Practice Address - Country:US
Practice Address - Phone:651-245-3505
Practice Address - Fax:651-846-6866
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-26
Last Update Date:2014-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1202106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty