Provider Demographics
NPI:1164826327
Name:JAKUBUS, JAMIE (MA)
Entity Type:Individual
Prefix:MR
First Name:JAMIE
Middle Name:
Last Name:JAKUBUS
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:57224 TANGLEWOOD ST
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:MI
Mailing Address - Zip Code:48048-2993
Mailing Address - Country:US
Mailing Address - Phone:734-548-1764
Mailing Address - Fax:734-548-1764
Practice Address - Street 1:57224 TANGLEWOOD ST
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:MI
Practice Address - Zip Code:48048-2993
Practice Address - Country:US
Practice Address - Phone:734-548-1764
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-17
Last Update Date:2019-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401014500101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor