Provider Demographics
NPI:1124484340
Name:JACOBS, CHRISTIAN JON (LMFT)
Entity type:Individual
Prefix:MR
First Name:CHRISTIAN
Middle Name:JON
Last Name:JACOBS
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:MR
Other - First Name:CHRISTIAN
Other - Middle Name:JON
Other - Last Name:JACOBS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMFT
Mailing Address - Street 1:9563 LAKEWIND LN
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95758-4658
Mailing Address - Country:US
Mailing Address - Phone:916-802-2678
Mailing Address - Fax:
Practice Address - Street 1:9563 LAKEWIND LN
Practice Address - Street 2:
Practice Address - City:ELK GROVE
Practice Address - State:CA
Practice Address - Zip Code:95758-4658
Practice Address - Country:US
Practice Address - Phone:916-802-2678
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-04
Last Update Date:2023-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X, 106H00000X
CA136637106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101Y00000XBehavioral Health & Social Service ProvidersCounselor