Provider Demographics
NPI:1346895554
Name:BELL, JACOBY (LMSW)
Entity Type:Individual
Prefix:MR
First Name:JACOBY
Middle Name:
Last Name:BELL
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:520 N 38TH AVE APT 3
Mailing Address - Street 2:
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39401-5733
Mailing Address - Country:US
Mailing Address - Phone:601-447-8680
Mailing Address - Fax:
Practice Address - Street 1:305 W MOODY ST
Practice Address - Street 2:
Practice Address - City:POPLARVILLE
Practice Address - State:MS
Practice Address - Zip Code:39470-7338
Practice Address - Country:US
Practice Address - Phone:601-240-2024
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-05
Last Update Date:2019-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSM95561041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical