Provider Demographics
NPI:1770319063
Name:JACOBSON, PAUL JAMES (TLMFT)
Entity type:Individual
Prefix:MR
First Name:PAUL
Middle Name:JAMES
Last Name:JACOBSON
Suffix:
Gender:M
Credentials:TLMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 CHRISTIAN PETERSEN AVE
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:IA
Mailing Address - Zip Code:50105-1018
Mailing Address - Country:US
Mailing Address - Phone:515-708-6575
Mailing Address - Fax:
Practice Address - Street 1:103 E 6TH ST STE 101
Practice Address - Street 2:
Practice Address - City:AMES
Practice Address - State:IA
Practice Address - Zip Code:50010-6300
Practice Address - Country:US
Practice Address - Phone:309-269-0033
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-12
Last Update Date:2024-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA125799106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty