Jacob Fredrick Van Allen, LADC

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

License

305300 Issued in MN

Practice address

1811 Weir Dr Ste 270
Woodbury, MN 55125-6741

Phone

(651) 714-9646

Fax

(651) 714-9647

NPI assigned

Jul 1, 2024

Last updated

Jul 1, 2024By the provider in NPPES

Sex

Male

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Family Support Services Inc.

  dba Sagent Behavioral Health

  • Mental Health Counselor
  • New Brighton, MN
  • NPI 1467549220
  NPD
• Nystrom & Associates, LTD

  dba Sagent Behavioral Health

  • Clinical Social Worker
  • New Brighton, MN
  • NPI 1396750188
  NPD

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

{
    "created_epoch": "1719792000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1719792000000",
    "number": "1801631767",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "240 5TH ST E APT 313",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "551011874"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1811 WEIR DR STE 270",
            "city": "WOODBURY",
            "state": "MN",
            "postal_code": "551256741",
            "telephone_number": "651-714-9646",
            "fax_number": "651-714-9647"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VAN ALLEN",
        "first_name": "JACOB",
        "middle_name": "FREDRICK",
        "credential": "LADC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2024-07-01",
        "last_updated": "2024-07-01",
        "certification_date": "2024-07-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "MN",
            "license": "305300",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Valhalla Place, LLC
• Valley Chiropractic Clinic, LTD
• Valley Creek Family Dentistry
• Valley Crossing Community School
• Maggie Rose Valois, MPS, LPCC, LADC
• Brittany Van Buskirk, LP
• Chelsae Marie Van Calligan
• Irma Johanna Van Der Valk, NP
• Palmer Vanbeest, LMFT
• Nancy Lee Vanburen, M.D.

• Addiction (Substance Use Disorder) Counselor in Woodbury, MN
• Providers in Woodbury, MN by specialty
• Addiction (Substance Use Disorder) Counselor in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 1, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.