Provider Demographics
NPI:1689285892
Name:SANTHOUSE, JACOB (EDD, LCPC)
Entity Type:Individual
Prefix:DR
First Name:JACOB
Middle Name:
Last Name:SANTHOUSE
Suffix:
Gender:M
Credentials:EDD, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16432 N MIDLAND BLVD # 78
Mailing Address - Street 2:
Mailing Address - City:NAMPA
Mailing Address - State:ID
Mailing Address - Zip Code:83687-5222
Mailing Address - Country:US
Mailing Address - Phone:312-883-4077
Mailing Address - Fax:
Practice Address - Street 1:10223 CHERRY LN APT 203
Practice Address - Street 2:
Practice Address - City:NAMPA
Practice Address - State:ID
Practice Address - Zip Code:83687-4344
Practice Address - Country:US
Practice Address - Phone:312-883-4077
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-11
Last Update Date:2022-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLPC.0017827101YP2500X
IL180013074101YP2500X
ID7778101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional