MEDICARE: BATSHEVA JACOBS MS MFTC

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
1	106H00000X	Marriage & Family Therapist	0014291	CO

General Provider Information

NPI Number	:	1558068668
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BATSHEVA JACOBS MS MFTC

Provider Business Mailing Address
First Line	:	4770 S XANTHIA ST
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80237-2951
Country	:	US
Telephone Number	:	650-815-8727
Fax Number	:

Provider Business Practice Location Address
First Line	:	13693 E ILIFF AVE
Second Line	:
City	:	AURORA
State	:	CO
Zip	:	80014-6527
Country	:	US
Telephone Number	:	720-788-0302
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/09/2023
Last Update Date	:	02/09/2023

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