Provider Demographics
NPI:1649491390
Name:JACOBS, MARY KAYE (MA, LPC, LMFT)
Entity type:Individual
Prefix:MRS
First Name:MARY
Middle Name:KAYE
Last Name:JACOBS
Suffix:
Gender:F
Credentials:MA, LPC, LMFT
Other - Prefix:MS
Other - First Name:MARY
Other - Middle Name:KAYE
Other - Last Name:SIMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, LPC, LMFT
Mailing Address - Street 1:502 KINGLAN ROAD
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40207-2332
Mailing Address - Country:US
Mailing Address - Phone:502-891-8809
Mailing Address - Fax:
Practice Address - Street 1:FAMILY CARE CENTER
Practice Address - Street 2:1425 STORY AVENUE
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40206
Practice Address - Country:US
Practice Address - Phone:502-584-1369
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY0648106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist