Provider Demographics
NPI:1710082706
Name:JACOBS, JIM R (LCSW)
Entity Type:Individual
Prefix:MR
First Name:JIM
Middle Name:R
Last Name:JACOBS
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10259 OURAY ST
Mailing Address - Street 2:
Mailing Address - City:COMMERCE CITY
Mailing Address - State:CO
Mailing Address - Zip Code:80022-7149
Mailing Address - Country:US
Mailing Address - Phone:303-288-2660
Mailing Address - Fax:
Practice Address - Street 1:3263 FRASER ST STE 3
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80011-1245
Practice Address - Country:US
Practice Address - Phone:303-371-1000
Practice Address - Fax:303-371-1002
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2010-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW80081041C0700X
CO8901041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical