Provider Demographics
NPI:1740446020
Name:JACOBS, DARREN E SR
Entity type:Individual
Prefix:
First Name:DARREN
Middle Name:E
Last Name:JACOBS
Suffix:SR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4588 N RANCHO DR
Mailing Address - Street 2:12
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89130-3426
Mailing Address - Country:US
Mailing Address - Phone:702-396-3464
Mailing Address - Fax:702-396-6164
Practice Address - Street 1:315 S 7TH ST
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89101-5801
Practice Address - Country:US
Practice Address - Phone:702-799-7800
Practice Address - Fax:702-799-1600
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-05
Last Update Date:2010-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV74303101YS0200X
172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool
No172V00000XOther Service ProvidersCommunity Health Worker