Provider Demographics
NPI:1871826875
Name:JACOBS, LORI BROWN (LLPC)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:BROWN
Last Name:JACOBS
Suffix:
Gender:F
Credentials:LLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28746 RAMBLEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48334-1748
Mailing Address - Country:US
Mailing Address - Phone:248-892-2915
Mailing Address - Fax:
Practice Address - Street 1:28746 RAMBLEWOOD DR
Practice Address - Street 2:
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48334-1748
Practice Address - Country:US
Practice Address - Phone:248-892-2915
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-09
Last Update Date:2009-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401011536101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional