Provider Demographics
NPI:1669154118
Name:CHABOT, JACOB (LLPC)
Entity type:Individual
Prefix:MR
First Name:JACOB
Middle Name:
Last Name:CHABOT
Suffix:
Gender:M
Credentials:LLPC
Other - Prefix:MR
Other - First Name:JAKE
Other - Middle Name:
Other - Last Name:CHABOT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LLPC
Mailing Address - Street 1:1514 LAFAYETTE AVE APT A23
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49006-5614
Mailing Address - Country:US
Mailing Address - Phone:313-414-1854
Mailing Address - Fax:
Practice Address - Street 1:2019 RAMBLING RD
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49008-1630
Practice Address - Country:US
Practice Address - Phone:269-345-0909
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-03
Last Update Date:2023-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional