Individual
MS. JANE GALVIN BACON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MA LP LMFT
Contact information
Practice address
1280 NORTH BIRCH LAKE BLVD, WHITE BEAR LAKE AREA COMMUNITY COUNSELING CENTER, WHITE BEAR LAKE, MN 55110-6708
(651) 429-8544
(651) 407-5301
Mailing address
1280 NORTH BIRCH LAKE BLVD, WHITE BEAR LAKE AREA COMMUNITY COUNSELING CENTER, WHITE BEAR LAKE, MN 55110-6708
(651) 429-8544
(651) 407-5301
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
LP2821
MN
106H00000X
Marriage & Family Therapist
Primary
320
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
103010
UCARE MINNESOTA
MN
01
—
30119
BEHAVIORAL HEALTCARE PROV
MN
01
—
56963BA
BLUE CROSS BLUE SHIELD
MN
Enumeration date
11/14/2006
Last updated
09/11/2025
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