Provider Demographics
NPI:1073625240
Name:JACOBS, KAREN LEE (LMFT)
Entity Type:Individual
Prefix:MRS
First Name:KAREN
Middle Name:LEE
Last Name:JACOBS
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3400 CENTRAL AVE
Mailing Address - Street 2:SUITE #310
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92506-2175
Mailing Address - Country:US
Mailing Address - Phone:951-781-9004
Mailing Address - Fax:951-781-9084
Practice Address - Street 1:3400 CENTRAL AVE
Practice Address - Street 2:SUITE #310
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92506-2175
Practice Address - Country:US
Practice Address - Phone:951-781-9004
Practice Address - Fax:951-781-9084
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14719106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist