Provider Demographics
NPI:1023376415
Name:JACOB, TIFFANY KRISTEN (MS, LPC)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:KRISTEN
Last Name:JACOB
Suffix:
Gender:F
Credentials:MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:824 EAGLE DR
Mailing Address - Street 2:
Mailing Address - City:EMMAUS
Mailing Address - State:PA
Mailing Address - Zip Code:18049-1900
Mailing Address - Country:US
Mailing Address - Phone:631-327-2261
Mailing Address - Fax:
Practice Address - Street 1:1005 BROOKSIDE RD
Practice Address - Street 2:SUITE 330
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18106-9023
Practice Address - Country:US
Practice Address - Phone:631-327-2261
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-24
Last Update Date:2015-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC006304101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional