Provider Demographics
NPI:1467051201
Name:JACOBS, JENNIFER JOELLE (MS, LPC, NCC)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:JOELLE
Last Name:JACOBS
Suffix:
Gender:F
Credentials:MS, LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5301 ALPHA RD APT 213
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75240-4359
Mailing Address - Country:US
Mailing Address - Phone:616-821-9047
Mailing Address - Fax:
Practice Address - Street 1:5301 ALPHA RD APT 213
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75240-4359
Practice Address - Country:US
Practice Address - Phone:469-708-9197
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-22
Last Update Date:2022-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401015576101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health