Provider Demographics
NPI:1134934086
Name:JACOBO, SAMANTHA (MFT ASSOCIATE)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:
Last Name:JACOBO
Suffix:
Gender:F
Credentials:MFT ASSOCIATE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 N CHELAN AVE
Mailing Address - Street 2:
Mailing Address - City:WENATCHEE
Mailing Address - State:WA
Mailing Address - Zip Code:98801-2105
Mailing Address - Country:US
Mailing Address - Phone:509-888-4866
Mailing Address - Fax:
Practice Address - Street 1:200 N CHELAN AVE
Practice Address - Street 2:
Practice Address - City:WENATCHEE
Practice Address - State:WA
Practice Address - Zip Code:98801-2105
Practice Address - Country:US
Practice Address - Phone:509-888-4866
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-10
Last Update Date:2025-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMFTA.MG.61671953106H00000X
IA125804106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist