Provider Demographics
NPI:1033231725
Name:BENNETT JACOBS, JANET (LCSW-ACP)
Entity Type:Individual
Prefix:
First Name:JANET
Middle Name:
Last Name:BENNETT JACOBS
Suffix:
Gender:F
Credentials:LCSW-ACP
Other - Prefix:
Other - First Name:JANET
Other - Middle Name:
Other - Last Name:BENNETT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:ACP
Mailing Address - Street 1:10300 N CENTRAL EXPY
Mailing Address - Street 2:SUITE 290
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75231-8600
Mailing Address - Country:US
Mailing Address - Phone:214-549-1239
Mailing Address - Fax:214-361-7515
Practice Address - Street 1:10300 N CENTRAL EXPY
Practice Address - Street 2:SUITE 290
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-8600
Practice Address - Country:US
Practice Address - Phone:214-549-1239
Practice Address - Fax:214-361-7515
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-04
Last Update Date:2009-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0154691041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1082737-02Medicaid
TX1082737-02Medicaid