Provider Demographics
NPI:1841558244
Name:JACOBS, JULIE LYNNE (MA LPC)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:LYNNE
Last Name:JACOBS
Suffix:
Gender:F
Credentials:MA LPC
Other - Prefix:
Other - First Name:JULIE
Other - Middle Name:LYNNE
Other - Last Name:JASKOLSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA LPC
Mailing Address - Street 1:1166 E WARNER ROAD
Mailing Address - Street 2:SUITE 203
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85296-3064
Mailing Address - Country:US
Mailing Address - Phone:480-459-9994
Mailing Address - Fax:480-907-1471
Practice Address - Street 1:1166 E WARNER RD
Practice Address - Street 2:SUITE 203
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85296-3064
Practice Address - Country:US
Practice Address - Phone:480-459-9994
Practice Address - Fax:480-907-1471
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-24
Last Update Date:2019-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC-12821101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional