Provider Demographics
NPI:1518718709
Name:JACOBSON, JOELLE (LMFT, PPS)
Entity Type:Individual
Prefix:
First Name:JOELLE
Middle Name:
Last Name:JACOBSON
Suffix:
Gender:F
Credentials:LMFT, PPS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 S BARRINGTON AVE UNIT 491713
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90049-7888
Mailing Address - Country:US
Mailing Address - Phone:310-922-5072
Mailing Address - Fax:
Practice Address - Street 1:200 S BARRINGTON AVE UNIT 491713
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90049-7888
Practice Address - Country:US
Practice Address - Phone:310-922-5072
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-27
Last Update Date:2024-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC48238106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist