Provider Demographics
NPI:1235545369
Name:JACOBS, MARAL (MS)
Entity Type:Individual
Prefix:MRS
First Name:MARAL
Middle Name:
Last Name:JACOBS
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2620 REGATTA DR STE 102
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89128-6892
Mailing Address - Country:US
Mailing Address - Phone:702-236-0452
Mailing Address - Fax:
Practice Address - Street 1:2620 REGATTA DR STE 102
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128-6892
Practice Address - Country:US
Practice Address - Phone:702-236-0452
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-09
Last Update Date:2022-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVCP0155101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health