1841558244 NPI number — JULIE LYNNE JACOBS MA LPC

Table of content: JULIE LYNNE JACOBS MA LPC (NPI 1841558244)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841558244 NPI number — JULIE LYNNE JACOBS MA LPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JACOBS
Provider First Name:
JULIE
Provider Middle Name:
LYNNE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MA LPC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
JASKOLSKI
Provider Other First Name:
JULIE
Provider Other Middle Name:
LYNNE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MA LPC
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1841558244
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/22/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1166 E WARNER ROAD
Provider Second Line Business Mailing Address:
SUITE 203
Provider Business Mailing Address City Name:
GILBERT
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85296-3064
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
480-459-9994
Provider Business Mailing Address Fax Number:
480-907-1471

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1166 E WARNER RD
Provider Second Line Business Practice Location Address:
SUITE 203
Provider Business Practice Location Address City Name:
GILBERT
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85296-3064
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
480-459-9994
Provider Business Practice Location Address Fax Number:
480-907-1471
Provider Enumeration Date:
04/24/2012

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X , with the licence number:  LPC-12821 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)