Provider Demographics
NPI:1598468290
Name:TOLER, JACOB (LPC)
Entity Type:Individual
Prefix:
First Name:JACOB
Middle Name:
Last Name:TOLER
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:811 MURPHY LN
Mailing Address - Street 2:
Mailing Address - City:FRIENDSWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:77546-4731
Mailing Address - Country:US
Mailing Address - Phone:832-858-5253
Mailing Address - Fax:
Practice Address - Street 1:820 S FRIENDSWOOD DR STE 213
Practice Address - Street 2:
Practice Address - City:FRIENDSWOOD
Practice Address - State:TX
Practice Address - Zip Code:77546-4591
Practice Address - Country:US
Practice Address - Phone:281-819-0191
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-23
Last Update Date:2023-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX83071101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional