Provider Demographics
NPI:1164592747
Name:JACOBSON, LOUISE A (NCC)
Entity Type:Individual
Prefix:MRS
First Name:LOUISE
Middle Name:A
Last Name:JACOBSON
Suffix:
Gender:F
Credentials:NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4868 MARCO POLO ST
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89031-0267
Mailing Address - Country:US
Mailing Address - Phone:702-526-3455
Mailing Address - Fax:702-586-1114
Practice Address - Street 1:4868 MARCO POLO ST
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89031-0267
Practice Address - Country:US
Practice Address - Phone:702-526-3455
Practice Address - Fax:702-586-1114
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-09
Last Update Date:2009-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND27648101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor