Provider Demographics
NPI:1356525513
Name:J TABORN ASSOCIATES INC
Entity type:Organization
Organization Name:J TABORN ASSOCIATES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE-PRES./LICENSED PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JOYCE
Authorized Official - Middle Name:TABORN
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:612-338-9012
Mailing Address - Street 1:1219 MARQUETTE AVE
Mailing Address - Street 2:SUITE 80
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55403-2489
Mailing Address - Country:US
Mailing Address - Phone:612-338-9012
Mailing Address - Fax:612-338-9020
Practice Address - Street 1:1219 MARQUETTE AVE
Practice Address - Street 2:SUITE 80
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55403-2488
Practice Address - Country:US
Practice Address - Phone:612-338-9012
Practice Address - Fax:612-338-9020
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-24
Last Update Date:2007-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP2524103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty