Provider Demographics
NPI:1659313591
Name:JACOBS, MARCUS THURL (LMHC, ICAC)
Entity Type:Individual
Prefix:MR
First Name:MARCUS
Middle Name:THURL
Last Name:JACOBS
Suffix:
Gender:M
Credentials:LMHC, ICAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:427 N 6TH ST
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47901-1189
Mailing Address - Country:US
Mailing Address - Phone:765-420-0938
Mailing Address - Fax:765-420-8218
Practice Address - Street 1:427 N 6TH ST
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47901-1189
Practice Address - Country:US
Practice Address - Phone:765-420-0938
Practice Address - Fax:765-420-8218
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN39000008A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health