Provider Demographics
NPI:1376299826
Name:JACOBS, CARRIE ELIZABETH X (MA, PSYD, CCS)
Entity Type:Individual
Prefix:DR
First Name:CARRIE
Middle Name:ELIZABETH
Last Name:JACOBS
Suffix:X
Gender:F
Credentials:MA, PSYD, CCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17335 TOQUET DR
Mailing Address - Street 2:
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91316-3944
Mailing Address - Country:US
Mailing Address - Phone:818-419-4582
Mailing Address - Fax:
Practice Address - Street 1:17335 TOQUET DR
Practice Address - Street 2:
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91316-3944
Practice Address - Country:US
Practice Address - Phone:818-419-4582
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-23
Last Update Date:2022-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103T00000X, 101Y00000X
CA31202106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist