Provider Demographics
NPI:1952181992
Name:LISA JACOBSON LCSW LLC
Entity Type:Organization
Organization Name:LISA JACOBSON LCSW LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:M
Authorized Official - Last Name:JACOBSON
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:307-680-4154
Mailing Address - Street 1:2225 FLINT RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73003-2481
Mailing Address - Country:US
Mailing Address - Phone:307-680-4154
Mailing Address - Fax:
Practice Address - Street 1:2529 S KELLY AVE STE C
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73013-2976
Practice Address - Country:US
Practice Address - Phone:405-467-0894
Practice Address - Fax:405-562-1975
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-05
Last Update Date:2023-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty