Provider Demographics
NPI:1841602414
Name:CLINEBELL, JACOB (MA)
Entity Type:Individual
Prefix:
First Name:JACOB
Middle Name:
Last Name:CLINEBELL
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 E GREEN ST
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18109-1825
Mailing Address - Country:US
Mailing Address - Phone:610-799-8910
Mailing Address - Fax:610-776-1694
Practice Address - Street 1:5300 KIDSPEACE DR
Practice Address - Street 2:
Practice Address - City:OREFIELD
Practice Address - State:PA
Practice Address - Zip Code:18069-2044
Practice Address - Country:US
Practice Address - Phone:610-799-8910
Practice Address - Fax:610-776-1694
Is Sole Proprietor?:No
Enumeration Date:2014-05-29
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1326173360Medicaid