Provider Demographics
NPI:1760605927
Name:JACOBS, JANET (LMFT)
Entity Type:Individual
Prefix:
First Name:JANET
Middle Name:
Last Name:JACOBS
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1915 PORT WEYBRIDGE PL
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-5432
Mailing Address - Country:US
Mailing Address - Phone:949-476-1214
Mailing Address - Fax:949-644-9426
Practice Address - Street 1:19742 MACARTHUR BLVD STE 145
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92612-2430
Practice Address - Country:US
Practice Address - Phone:949-476-1214
Practice Address - Fax:949-644-9426
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT 29088106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist