Provider Demographics
NPI:1407565286
Name:GOLDSTEIN JACOBS, ALANA (LPC)
Entity Type:Individual
Prefix:
First Name:ALANA
Middle Name:
Last Name:GOLDSTEIN JACOBS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2650 SUN MEADOW DR
Mailing Address - Street 2:
Mailing Address - City:WILDWOOD
Mailing Address - State:MO
Mailing Address - Zip Code:63005-7018
Mailing Address - Country:US
Mailing Address - Phone:314-722-6698
Mailing Address - Fax:
Practice Address - Street 1:2650 SUN MEADOW DR
Practice Address - Street 2:
Practice Address - City:WILDWOOD
Practice Address - State:MO
Practice Address - Zip Code:63005-7018
Practice Address - Country:US
Practice Address - Phone:314-722-6698
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-21
Last Update Date:2022-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2020034488101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional