Provider Demographics
NPI:1184447229
Name:TAKEN, JACOB ALLEN (LPC)
Entity type:Individual
Prefix:
First Name:JACOB
Middle Name:ALLEN
Last Name:TAKEN
Suffix:
Gender:
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3320 PETERSON RD STE 104
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66049-1739
Mailing Address - Country:US
Mailing Address - Phone:785-371-1414
Mailing Address - Fax:
Practice Address - Street 1:3320 PETERSON RD STE 104
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66049-1739
Practice Address - Country:US
Practice Address - Phone:785-371-1414
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-06
Last Update Date:2025-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSLPC04900101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional