Provider Demographics
NPI:1033665716
Name:JACOBSON, TERESA (DBH, LPCC-S)
Entity Type:Individual
Prefix:DR
First Name:TERESA
Middle Name:
Last Name:JACOBSON
Suffix:
Gender:F
Credentials:DBH, LPCC-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1081B STATE ROUTE 28 STE 180
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:OH
Mailing Address - Zip Code:45150-2001
Mailing Address - Country:US
Mailing Address - Phone:513-206-3026
Mailing Address - Fax:
Practice Address - Street 1:1440 NORWAY KNOLL CT
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:OH
Practice Address - Zip Code:45150-7512
Practice Address - Country:US
Practice Address - Phone:513-206-3026
Practice Address - Fax:513-620-5642
Is Sole Proprietor?:No
Enumeration Date:2016-08-31
Last Update Date:2023-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE.1200234101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional