Christine M Anderson Jacob, PH.D, LP

Primary specialty

Counseling PsychologistTaxonomy code 103TC1900X

License

4727 Issued in MN

Practice address

2124 Dupont Ave S Ste 300
Minneapolis, MN 55405-2735

Phone

(612) 879-1010

Fax

(612) 879-0059

NPI assigned

Jun 13, 2007

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MN

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Psychologist

Education

Other, 2003

Medicare assignment

May accept Medicare assignment

Telehealth

Offers telehealth services

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Cmaj, Inc

  • Counseling Psychologist
  • Arden Hills, MN
  • NPI 1083088462
  Medicare reassignment NPD

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

{
    "created_epoch": "1181692800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1432684800000",
    "number": "1184828204",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1492 ARDEN PL",
            "city": "ARDEN HILLS",
            "state": "MN",
            "postal_code": "551123626",
            "telephone_number": "651-487-6303"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2124 DUPONT AVE S STE 300",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554052735",
            "telephone_number": "612-879-1010",
            "fax_number": "612-879-0059"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ANDERSON JACOB",
        "first_name": "CHRISTINE",
        "middle_name": "M",
        "name_prefix": "Dr.",
        "credential": "PH.D, LP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-06-13",
        "last_updated": "2015-05-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC1900X",
            "taxonomy_group": "",
            "desc": "Psychologist, Counseling",
            "state": "MN",
            "license": "4727",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Carli J Andersen, LICSW
• Emily Andersen
• Eric Michael Andersen, DPT
• Kara Andersen, MD
• Lorick Elene Andersen, MD
• Anderson Psychological Services, L.L.C.
• Elise Anderson-Ehrman, PA-C
• William Mitchell Anderson-Freske, MD
• Teresa Lynn Anderson-Haag, PHARM.D.
• Steven Alan Anderson-Hermann, MD

• Counseling Psychologist in Minneapolis, MN
• Providers in Minneapolis, MN by specialty
• Counseling Psychologist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 27, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.