Provider Demographics
NPI:1942931464
Name:JACOB, JESSICA NICOLE (LMFT-A)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:NICOLE
Last Name:JACOB
Suffix:
Gender:F
Credentials:LMFT-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:608 FM 1770
Mailing Address - Street 2:
Mailing Address - City:WINTERS
Mailing Address - State:TX
Mailing Address - Zip Code:79567-7301
Mailing Address - Country:US
Mailing Address - Phone:325-320-3872
Mailing Address - Fax:
Practice Address - Street 1:600 NOVICE RD
Practice Address - Street 2:
Practice Address - City:WINTERS
Practice Address - State:TX
Practice Address - Zip Code:79567
Practice Address - Country:US
Practice Address - Phone:325-896-4174
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-24
Last Update Date:2022-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX204630101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health