Provider Demographics
NPI:1295433837
Name:MALLOVE, JAKOB HARVEY (MA, AMFT)
Entity type:Individual
Prefix:
First Name:JAKOB
Middle Name:HARVEY
Last Name:MALLOVE
Suffix:
Gender:M
Credentials:MA, AMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8443 BLACKBURN AVE APT 7
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90048-4153
Mailing Address - Country:US
Mailing Address - Phone:206-930-9570
Mailing Address - Fax:
Practice Address - Street 1:1151 N LA BREA AVE
Practice Address - Street 2:
Practice Address - City:WEST HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:90038-1021
Practice Address - Country:US
Practice Address - Phone:213-201-1450
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-22
Last Update Date:2023-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA137790103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Multi-Specialty