Provider Demographics
NPI:1558124594
Name:JACOB'S LADDER THERAPIES
Entity Type:Organization
Organization Name:JACOB'S LADDER THERAPIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:TAMETRA
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:408-471-4261
Mailing Address - Street 1:950 S BASCOM AVE STE 1014
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95128-3537
Mailing Address - Country:US
Mailing Address - Phone:408-471-4261
Mailing Address - Fax:408-608-3986
Practice Address - Street 1:950 S BASCOM AVE STE 1014
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95128-3537
Practice Address - Country:US
Practice Address - Phone:408-471-4261
Practice Address - Fax:408-608-3986
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-02
Last Update Date:2024-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty