Individual
DR. JARED BRENT BOSTROM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LMFT, LADC, CPRP
Contact information
Practice address
1100 E 80TH ST, BLOOMINGTON, MN 55420-1426
(952) 956-3101
(952) 564-3031
Mailing address
1100 E 80TH ST STE 100, BLOOMINGTON, MN 55420-1426
(952) 956-3101
(952) 564-3031
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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