Provider Information for 1124484340
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Mr. CHRISTIAN JON JACOBS LMFT
Other Names:Professional Name:Mr. CHRISTIAN JON JACOBS LMFTSex: Male
NPI: 1124484340
Last Updated: 2023-01-03
Certification Date: 2023-01-03
Certification Date: 2023-01-03
Details
| Name | Value | ||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| NPI | 1124484340 | ||||||||||||||||
| Enumeration Date | 2016-01-04 | ||||||||||||||||
| NPI Type | NPI-1 Individual | ||||||||||||||||
| Sole Proprietor | NO | ||||||||||||||||
| Status | Active | ||||||||||||||||
| Mailing Address | 9563 LAKEWIND LN ELK GROVE, CA 95758-4658 United States Phone: 916-802-2678 | Fax: | ||||||||||||||||
| Primary Practice Address | 9563 LAKEWIND LN ELK GROVE, CA 95758-4658 United States Phone: 916-802-2678 | Fax: | ||||||||||||||||
| Secondary Practice Address(es) | 2101 COURAGE DR | ||||||||||||||||
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