Provider Demographics
NPI:1659926665
Name:SCHOTT, JACOB ROGER (LPC, NCC, CCTS-I)
Entity Type:Individual
Prefix:
First Name:JACOB
Middle Name:ROGER
Last Name:SCHOTT
Suffix:
Gender:M
Credentials:LPC, NCC, CCTS-I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7500 N DREAMY DRAW DR STE 145
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85020-4668
Mailing Address - Country:US
Mailing Address - Phone:480-882-4545
Mailing Address - Fax:602-409-0499
Practice Address - Street 1:16251 N CAVE CREEK RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85032-2976
Practice Address - Country:US
Practice Address - Phone:602-910-2941
Practice Address - Fax:602-409-0499
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-06
Last Update Date:2024-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ22149101YP2500X
AZLPC-22149101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ137997Medicaid