Individual
JACOB LOUIS SPEHAR
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MA, LPCC, LADC
Contact information
Practice address
155 LAKE ST S STE 102, FOREST LAKE, MN 55025-2604
(651) 461-1438
Mailing address
5824 213TH ST N, FOREST LAKE, MN 55025-9745
(651) 226-7906
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
303864
MN
101YM0800X
Mental Health Counselor
Primary
CC01722
MN
Other
Enumeration date
03/15/2018
Last updated
03/04/2024
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