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Individual
DR. JARED BRENT BOSTROM
Active
Individual
DR. JARED BRENT BOSTROM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LMFT, LADC, CPRP
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
4866770
MN
101YA0400X
Addiction (Substance Use Disorder) Counselor
303234
MN
101YM0800X
Mental Health Counselor
Primary
4866770
MN
106H00000X
Marriage & Family Therapist
2913
MN
Other
Enumeration date
01/26/2012
Last updated
11/22/2019
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