Provider Demographics
NPI:1932296936
Name:JACOBS, GARY M (LPC)
Entity Type:Individual
Prefix:MR
First Name:GARY
Middle Name:M
Last Name:JACOBS
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6314 GLENMOOR DR
Mailing Address - Street 2:
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75043-5927
Mailing Address - Country:US
Mailing Address - Phone:972-226-1874
Mailing Address - Fax:
Practice Address - Street 1:1353 N WESTMORELAND RD
Practice Address - Street 2:BLDG. A
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75211-1655
Practice Address - Country:US
Practice Address - Phone:214-333-7015
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX16003101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional