Cmaj, Inc

Primary specialty

Counseling PsychologistTaxonomy code 103TC1900X

License

4727 Issued in MN

Legal business name

CMAJ, INC

Practice address

3820 Cleveland Ave N Ste 400
Arden Hills, MN 55112

Phone

(651) 389-4406

Fax

(651) 389-4410

NPI assigned

Nov 22, 2015

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Christine Anderson Jacob, PH.D, LP

Title

President/Psychologist

Phone

(651) 485-8173

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MN

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Christine M Anderson Jacob, PH.D, LP

  • Counseling Psychologist
  • Minneapolis, MN
  • NPI 1184828204
  Medicare reassignment NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1448150400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1528675200000",
    "number": "1083088462",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3820 CLEVELAND AVE N STE 400",
            "city": "ARDEN HILLS",
            "state": "MN",
            "postal_code": "551123297",
            "telephone_number": "651-389-4406",
            "fax_number": "651-389-4410"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3820 CLEVELAND AVE N STE 400",
            "city": "ARDEN HILLS",
            "state": "MN",
            "postal_code": "55112",
            "telephone_number": "651-389-4406",
            "fax_number": "651-389-4410"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2124 DuPont Ave S Ste 300",
            "address_purpose": "LOCATION",
            "city": "Minneapolis",
            "state": "MN",
            "postal_code": "554052735",
            "country_code": "US",
            "telephone_number": "651-485-8173",
            "fax_number": "612-879-0059",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "CMAJ, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-11-22",
        "last_updated": "2018-06-11",
        "status": "A",
        "authorized_official_last_name": "JACOB",
        "authorized_official_first_name": "CHRISTINE",
        "authorized_official_middle_name": "ANDERSON",
        "authorized_official_title_or_position": "PRESIDENT/PSYCHOLOGIST",
        "authorized_official_telephone_number": "651-485-8173",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PH.D, LP"
    },
    "taxonomies": [
        {
            "code": "103TC1900X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist, Counseling",
            "state": "MN",
            "license": "4727",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Counseling Psychologist in Arden Hills, MN
• Providers in Arden Hills, MN by specialty
• Counseling Psychologist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 11, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.