Provider Demographics
NPI:1649703414
Name:BEALL, JENNIFER E (LPCC)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:E
Last Name:BEALL
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3410 FEDERAL DR STE 101
Mailing Address - Street 2:
Mailing Address - City:EAGAN
Mailing Address - State:MN
Mailing Address - Zip Code:55122-1337
Mailing Address - Country:US
Mailing Address - Phone:651-560-0050
Mailing Address - Fax:651-925-0257
Practice Address - Street 1:303 21ST ST
Practice Address - Street 2:SUITE 232
Practice Address - City:NEWPORT
Practice Address - State:MN
Practice Address - Zip Code:55055-1094
Practice Address - Country:US
Practice Address - Phone:651-560-0050
Practice Address - Fax:651-925-0257
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-07
Last Update Date:2023-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLPCC 1491101YP2500X
AZLPC19739101YP2500X
WILPC7911101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional