Provider Demographics
NPI:1225640071
Name:JACOBSON, IRINA (LPC-INTERN)
Entity Type:Individual
Prefix:
First Name:IRINA
Middle Name:
Last Name:JACOBSON
Suffix:
Gender:F
Credentials:LPC-INTERN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11777 KATY FWY STE 350
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77079-1721
Mailing Address - Country:US
Mailing Address - Phone:713-365-0700
Mailing Address - Fax:713-827-1080
Practice Address - Street 1:11777 KATY FWY STE 350
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77079-1721
Practice Address - Country:US
Practice Address - Phone:713-365-0700
Practice Address - Fax:713-827-1080
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-21
Last Update Date:2020-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX83844101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX83844OtherTX STATE BOARD OF EXAMNERS OF PROFESSIONAL COUNSELORS