Provider Demographics
NPI:1942667076
Name:JACOBS, JAMELL J (MED, NCC, PLPC)
Entity Type:Individual
Prefix:
First Name:JAMELL
Middle Name:J
Last Name:JACOBS
Suffix:
Gender:F
Credentials:MED, NCC, PLPC
Other - Prefix:
Other - First Name:JAMELL
Other - Middle Name:J
Other - Last Name:CARNES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3609 THYME DR
Mailing Address - Street 2:
Mailing Address - City:SAINT CHARLES
Mailing Address - State:MO
Mailing Address - Zip Code:63303-6330
Mailing Address - Country:US
Mailing Address - Phone:310-766-9616
Mailing Address - Fax:
Practice Address - Street 1:111 CHURCH ST
Practice Address - Street 2:SUITE 103
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63135-2441
Practice Address - Country:US
Practice Address - Phone:314-485-7330
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-20
Last Update Date:2016-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2015043578101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health