Provider Demographics
NPI:1821673633
Name:JACOBS, TAYLOR (LPC)
Entity Type:Individual
Prefix:
First Name:TAYLOR
Middle Name:
Last Name:JACOBS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14924 DOGWOOD DR
Mailing Address - Street 2:
Mailing Address - City:ORLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60462-3457
Mailing Address - Country:US
Mailing Address - Phone:708-822-3467
Mailing Address - Fax:
Practice Address - Street 1:11227 DISTINCTIVE DR
Practice Address - Street 2:
Practice Address - City:ORLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60467-9458
Practice Address - Country:US
Practice Address - Phone:708-473-2445
Practice Address - Fax:815-201-8228
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-12
Last Update Date:2021-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178016632101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional