Provider Demographics
NPI:1164021325
Name:JACOBS, LARA MEGAN (LLPC)
Entity Type:Individual
Prefix:MRS
First Name:LARA
Middle Name:MEGAN
Last Name:JACOBS
Suffix:
Gender:F
Credentials:LLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1819 GULL RD
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49048-1611
Mailing Address - Country:US
Mailing Address - Phone:269-381-9800
Mailing Address - Fax:269-381-2932
Practice Address - Street 1:1441 S WESTNEDGE AVE
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49008-1370
Practice Address - Country:US
Practice Address - Phone:269-381-9800
Practice Address - Fax:269-381-2932
Is Sole Proprietor?:No
Enumeration Date:2020-10-20
Last Update Date:2020-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional