Provider Demographics
NPI:1265838064
Name:JACOBS, LAURA ZELL (MFTI)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:ZELL
Last Name:JACOBS
Suffix:
Gender:F
Credentials:MFTI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1513 SPORTS DR
Mailing Address - Street 2:100
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95834-1943
Mailing Address - Country:US
Mailing Address - Phone:916-575-8851
Mailing Address - Fax:916-575-8861
Practice Address - Street 1:1513 SPORTS DR
Practice Address - Street 2:100
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95834-1943
Practice Address - Country:US
Practice Address - Phone:916-575-8851
Practice Address - Fax:916-575-8861
Is Sole Proprietor?:No
Enumeration Date:2014-11-06
Last Update Date:2014-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA68-0483034101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)