Provider Demographics
NPI:1275705592
Name:JEENA JACOB INC.
Entity Type:Organization
Organization Name:JEENA JACOB INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JEENA
Authorized Official - Middle Name:GEORGE
Authorized Official - Last Name:JACOB
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:847-912-8958
Mailing Address - Street 1:1173 ANCIENT OAKS CT
Mailing Address - Street 2:
Mailing Address - City:BARTLETT
Mailing Address - State:IL
Mailing Address - Zip Code:60103-1711
Mailing Address - Country:US
Mailing Address - Phone:847-912-8958
Mailing Address - Fax:
Practice Address - Street 1:1721 MOON LAKE BLVD STE 150
Practice Address - Street 2:
Practice Address - City:HOFFMAN ESTATES
Practice Address - State:IL
Practice Address - Zip Code:60169-1069
Practice Address - Country:US
Practice Address - Phone:847-519-3650
Practice Address - Fax:847-519-3652
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-26
Last Update Date:2008-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty