Provider Demographics
NPI:1932361599
Name:JACOBS, SPENCER BARRETT (MFT)
Entity Type:Individual
Prefix:MRS
First Name:SPENCER
Middle Name:BARRETT
Last Name:JACOBS
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:495 MILLER AVE
Mailing Address - Street 2:SUITE 105
Mailing Address - City:MILL VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:94941-5837
Mailing Address - Country:US
Mailing Address - Phone:415-310-5650
Mailing Address - Fax:
Practice Address - Street 1:495 MILLER AVE
Practice Address - Street 2:SUITE 105
Practice Address - City:MILL VALLEY
Practice Address - State:CA
Practice Address - Zip Code:94941-5837
Practice Address - Country:US
Practice Address - Phone:415-968-5566
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-25
Last Update Date:2016-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA50045106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist