Provider Demographics
NPI:1710528971
Name:MESSMER, JACOB SCOTT (LPCC)
Entity Type:Individual
Prefix:
First Name:JACOB
Middle Name:SCOTT
Last Name:MESSMER
Suffix:
Gender:M
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 EDGEWOOD RD
Mailing Address - Street 2:
Mailing Address - City:EDGEWOOD
Mailing Address - State:KY
Mailing Address - Zip Code:41017-2315
Mailing Address - Country:US
Mailing Address - Phone:859-409-3060
Mailing Address - Fax:
Practice Address - Street 1:1455 S FORT THOMAS AVE
Practice Address - Street 2:
Practice Address - City:FORT THOMAS
Practice Address - State:KY
Practice Address - Zip Code:41075-2453
Practice Address - Country:US
Practice Address - Phone:859-442-8439
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-30
Last Update Date:2021-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC.1901635101YM0800X
KY269644101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health