Provider Demographics
NPI:1033459649
Name:JACOBS, MICHELLE L (LPC)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:L
Last Name:JACOBS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1301 N HIGH ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43201-2460
Mailing Address - Country:US
Mailing Address - Phone:614-374-8402
Mailing Address - Fax:
Practice Address - Street 1:1301 N HIGH ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43201-2460
Practice Address - Country:US
Practice Address - Phone:614-299-6600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-19
Last Update Date:2023-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC.2204418101YM0800X
OHRN.518330163W00000X, 163WP0809X
OHPN 95769164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No163W00000XNursing Service ProvidersRegistered Nurse
No164W00000XNursing Service ProvidersLicensed Practical NurseGroup - Single Specialty