Provider Demographics
NPI:1346328895
Name:JACOBS, PAUL C (PHD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:C
Last Name:JACOBS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24255 W 13 MILE RD
Mailing Address - Street 2:SUITE 280
Mailing Address - City:BINGHAM FARMS
Mailing Address - State:MI
Mailing Address - Zip Code:48025-4320
Mailing Address - Country:US
Mailing Address - Phone:248-723-2757
Mailing Address - Fax:248-723-2707
Practice Address - Street 1:24255 W 13 MILE RD
Practice Address - Street 2:SUITE 280
Practice Address - City:BINGHAM FARMS
Practice Address - State:MI
Practice Address - Zip Code:48025-4320
Practice Address - Country:US
Practice Address - Phone:248-723-2757
Practice Address - Fax:248-723-2707
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301001260103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIO F3 4670OtherBLUE CROSS/BLUE SHIELD
MIO F3 4670OtherBLUE CROSS/BLUE SHIELD