Provider Demographics
NPI:1578629234
Name:JACOBS, KARL FLINT (PSYD)
Entity Type:Individual
Prefix:DR
First Name:KARL
Middle Name:FLINT
Last Name:JACOBS
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1135 MAKAWAO AVE
Mailing Address - Street 2:SUITE 226
Mailing Address - City:MAKAWAO
Mailing Address - State:HI
Mailing Address - Zip Code:96768
Mailing Address - Country:US
Mailing Address - Phone:808-572-0631
Mailing Address - Fax:808-572-3090
Practice Address - Street 1:1135 MAKAWAO AVE
Practice Address - Street 2:SUITE 226
Practice Address - City:MAKAWAO
Practice Address - State:HI
Practice Address - Zip Code:96768
Practice Address - Country:US
Practice Address - Phone:808-572-0631
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPSY622103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI00232501Medicaid
HI00232501Medicaid
HIH51089Medicare ID - Type Unspecified