Provider Demographics
NPI:1235477746
Name:HUSBY, JAN MICHAEL (BS)
Entity type:Individual
Prefix:MR
First Name:JAN MICHAEL
Middle Name:
Last Name:HUSBY
Suffix:
Gender:M
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3300 COUNTY ROAD 10
Mailing Address - Street 2:SUITE 514
Mailing Address - City:BROOKLYN CENTER
Mailing Address - State:MN
Mailing Address - Zip Code:55429-3072
Mailing Address - Country:US
Mailing Address - Phone:763-746-0015
Mailing Address - Fax:763-561-1843
Practice Address - Street 1:3300 COUNTY ROAD 10
Practice Address - Street 2:SUITE 514
Practice Address - City:BROOKLYN CENTER
Practice Address - State:MN
Practice Address - Zip Code:55429-3072
Practice Address - Country:US
Practice Address - Phone:763-746-0015
Practice Address - Fax:763-561-1843
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-18
Last Update Date:2013-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health