Provider Demographics
NPI:1396724936
Name:JACOBSON, BETHANNE THUMM (PHD)
Entity type:Individual
Prefix:DR
First Name:BETHANNE
Middle Name:THUMM
Last Name:JACOBSON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2807 NEUSE BLVD
Mailing Address - Street 2:STE 5
Mailing Address - City:NEW BERN
Mailing Address - State:NC
Mailing Address - Zip Code:28562-2815
Mailing Address - Country:US
Mailing Address - Phone:252-636-0112
Mailing Address - Fax:252-634-9778
Practice Address - Street 1:2807 NEUSE BLVD
Practice Address - Street 2:STE 5
Practice Address - City:NEW BERN
Practice Address - State:NC
Practice Address - Zip Code:28562-2815
Practice Address - Country:US
Practice Address - Phone:252-636-0112
Practice Address - Fax:252-634-9778
Is Sole Proprietor?:No
Enumeration Date:2006-01-12
Last Update Date:2010-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3037103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1396724936OtherHEALTH NET TRICARE FEDERAL SERVICES
NC135A8OtherBCBSNC
NC6000484Medicaid
NC135A8OtherBCBSNC