Provider Demographics
NPI:1922402700
Name:JACOBSON, CATHLEEN CARMEL (LMFT)
Entity Type:Individual
Prefix:
First Name:CATHLEEN
Middle Name:CARMEL
Last Name:JACOBSON
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:CATHLEEN
Other - Middle Name:CARMEL
Other - Last Name:TURPIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMFT
Mailing Address - Street 1:1401 W CARRIAGE DR
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92704-6712
Mailing Address - Country:US
Mailing Address - Phone:949-228-5030
Mailing Address - Fax:
Practice Address - Street 1:1401 WEST CARRIAGE DRIVE
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92704-6712
Practice Address - Country:US
Practice Address - Phone:949-228-5030
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-22
Last Update Date:2017-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA41701261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)