Provider Demographics
NPI:1003687047
Name:DOERING, JACOB TYLER (MS, LPC, NCC, CRC)
Entity Type:Individual
Prefix:
First Name:JACOB
Middle Name:TYLER
Last Name:DOERING
Suffix:
Gender:M
Credentials:MS, LPC, NCC, CRC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1009 MORTON HILL LN
Mailing Address - Street 2:
Mailing Address - City:HASLET
Mailing Address - State:TX
Mailing Address - Zip Code:76052-4124
Mailing Address - Country:US
Mailing Address - Phone:972-768-7541
Mailing Address - Fax:
Practice Address - Street 1:1300 FULTON ST STE 200
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76201-2688
Practice Address - Country:US
Practice Address - Phone:940-382-5328
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-09
Last Update Date:2024-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX87311101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty