Individual
STACIA JACOBSON-GRAY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPCC
Contact information
Practice address
3395 PLYMOUTH RD, MINNETONKA, MN 55305-3765
(952) 939-0396
(952) 548-8760
Mailing address
3395 PLYMOUTH RD, MINNETONKA, MN 55305-3765
(952) 939-0396
(952) 548-8760
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
101YP2500X
Professional Counselor
Primary
CC01218
MN
Other
Enumeration date
02/18/2011
Last updated
05/16/2016
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