Provider Demographics
NPI:1639365489
Name:JACOBS, TAMMY MARIA (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:TAMMY
Middle Name:MARIA
Last Name:JACOBS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:848 N 91ST WAY
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85207-5102
Mailing Address - Country:US
Mailing Address - Phone:480-688-7414
Mailing Address - Fax:
Practice Address - Street 1:1845 S DOBSON RD
Practice Address - Street 2:SUITE 204
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85202-5661
Practice Address - Country:US
Practice Address - Phone:480-688-7414
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-14
Last Update Date:2009-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLCSW-119281041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical