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NPI Code Detail

MEDICARE: LISA R JACOBS PSYD

MEDICARE: LISA R JACOBS PSYD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103TC0700XClinical Psychologist2435CO

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
211605559OTHERCOCAQH PIN
3PSY.0002435OTHERCOPROFESSIONAL LICENSE

General Provider Information

NPI Number : 1538134127
Entity Type Code : Individual
Provider Name (Legal Business Name) : LISA R JACOBS PSYD
Provider Business Mailing Address
First Line : 2695 ROCKY MOUNTAIN AVE STE 150
Second Line :
City : LOVELAND
State : CO
Zip : 80538-9071
Country : US
Telephone Number : 970-624-4323
Fax Number :
Provider Business Practice Location Address
First Line : 4650 SIGNAL TREE DR STE 1200
Second Line :
City : TIMNATH
State : CO
Zip : 80547-4908
Country : US
Telephone Number : 970-237-7415
Fax Number : 970-237-7420
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/17/2006
Last Update Date : 05/19/2022

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Directions to “ LISA R JACOBS PSYD” Practice Location

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