Provider Demographics
NPI:1568195568
Name:JACOBS, IRENE LEIVAS (MC, LPC, CSAT)
Entity Type:Individual
Prefix:
First Name:IRENE
Middle Name:LEIVAS
Last Name:JACOBS
Suffix:
Gender:F
Credentials:MC, LPC, CSAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5930 E SPRING RD
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85254-5549
Mailing Address - Country:US
Mailing Address - Phone:602-214-6379
Mailing Address - Fax:
Practice Address - Street 1:7633 E ACOMA DR STE 210
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260-2908
Practice Address - Country:US
Practice Address - Phone:602-214-6379
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-06
Last Update Date:2022-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC13643101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional