Provider Demographics
NPI:1114532728
Name:JACOBUS, CHRISTIE (LPC-S : RN-BC)
Entity Type:Individual
Prefix:
First Name:CHRISTIE
Middle Name:
Last Name:JACOBUS
Suffix:
Gender:F
Credentials:LPC-S : RN-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 RAINBOW DR # 819
Mailing Address - Street 2:
Mailing Address - City:LIVINGSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77399-1008
Mailing Address - Country:US
Mailing Address - Phone:713-446-7699
Mailing Address - Fax:
Practice Address - Street 1:13313 SOUTHWEST FWY STE 263
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77478-4530
Practice Address - Country:US
Practice Address - Phone:713-446-7699
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-10
Last Update Date:2020-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX522023163WC1600X
TX61336101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No163WC1600XNursing Service ProvidersRegistered NurseContinuing Education/Staff Development