Provider Demographics
NPI:1396472122
Name:JACOBS, ANDREW B (LMSW)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:B
Last Name:JACOBS
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2410 CENTENNIAL BLVD
Mailing Address - Street 2:
Mailing Address - City:HAYS
Mailing Address - State:KS
Mailing Address - Zip Code:67601-2362
Mailing Address - Country:US
Mailing Address - Phone:785-656-4870
Mailing Address - Fax:
Practice Address - Street 1:208 E 8TH ST STE D
Practice Address - Street 2:
Practice Address - City:HAYS
Practice Address - State:KS
Practice Address - Zip Code:67601-4748
Practice Address - Country:US
Practice Address - Phone:785-222-0778
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-02
Last Update Date:2022-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS12663104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker