Provider Demographics
NPI:1073506226
Name:JACOBS, ANDREW A (PHD)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:A
Last Name:JACOBS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 W 47TH ST
Mailing Address - Street 2:STE 514
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64112-1251
Mailing Address - Country:US
Mailing Address - Phone:816-561-5556
Mailing Address - Fax:816-756-3151
Practice Address - Street 1:800 W 47TH ST
Practice Address - Street 2:STE 514
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64112-1251
Practice Address - Country:US
Practice Address - Phone:816-561-5556
Practice Address - Fax:816-756-3151
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-23
Last Update Date:2010-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR0244103T00000X, 103TE1100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TE1100XBehavioral Health & Social Service ProvidersPsychologistExercise & Sports
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO16045018OtherBCBS
MO16045018OtherBCBS