Provider Demographics
NPI:1912386160
Name:JACOBO, LIZETTE (MS MFTI)
Entity Type:Individual
Prefix:MISS
First Name:LIZETTE
Middle Name:
Last Name:JACOBO
Suffix:
Gender:F
Credentials:MS MFTI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:255 N FULTON ST
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93701-1600
Mailing Address - Country:US
Mailing Address - Phone:559-497-5056
Mailing Address - Fax:
Practice Address - Street 1:255 N FULTON ST
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93701-1600
Practice Address - Country:US
Practice Address - Phone:559-497-5056
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-20
Last Update Date:2015-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist