Provider Demographics
NPI:1376995167
Name:PERKINS, JACOB DAVID (LCSW, MSW)
Entity Type:Individual
Prefix:
First Name:JACOB
Middle Name:DAVID
Last Name:PERKINS
Suffix:
Gender:M
Credentials:LCSW, MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1176 TOWN AND COUNTRY COMMONS DR
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63017-8200
Mailing Address - Country:US
Mailing Address - Phone:314-251-2870
Mailing Address - Fax:
Practice Address - Street 1:1176 TOWN AND COUNTRY COMMONS DR
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63017-8200
Practice Address - Country:US
Practice Address - Phone:314-251-2870
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-06
Last Update Date:2022-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20210342841041C0700X, 1041C0700X
171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No171M00000XOther Service ProvidersCase Manager/Care Coordinator