Provider Demographics
NPI:1497816284
Name:JACOBI, KAREN A (PHD)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:A
Last Name:JACOBI
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:970 EXECUTIVE PARKWAY DR
Mailing Address - Street 2:ST. JOHN'S FAMILY THERAPY
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-6302
Mailing Address - Country:US
Mailing Address - Phone:314-628-6550
Mailing Address - Fax:314-514-9910
Practice Address - Street 1:970 EXECUTIVE PARKWAY DR
Practice Address - Street 2:ST. JOHN'S FAMILY THERAPY
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-6302
Practice Address - Country:US
Practice Address - Phone:314-628-6550
Practice Address - Fax:314-514-9910
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2007-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR0461103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOP52331Medicare ID - Type Unspecified