Provider Demographics
NPI:1598005183
Name:JACOBS LADDER PSYCHOLOGICAL SERVICES, PLLC
Entity Type:Organization
Organization Name:JACOBS LADDER PSYCHOLOGICAL SERVICES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KEISHA
Authorized Official - Middle Name:HOLLEY
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:281-785-7528
Mailing Address - Street 1:16823 GREEN QUAIL DR
Mailing Address - Street 2:
Mailing Address - City:MISSOURI CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77489-5301
Mailing Address - Country:US
Mailing Address - Phone:281-512-4734
Mailing Address - Fax:281-497-8380
Practice Address - Street 1:11201 RICHMOND AVE
Practice Address - Street 2:SUITE A-100A
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77082-6653
Practice Address - Country:US
Practice Address - Phone:281-512-4734
Practice Address - Fax:281-494-8380
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-19
Last Update Date:2013-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX35188103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty