MEDICARE: JANET JACOBS LMFT

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	LMFT 29088	CA

General Provider Information

NPI Number	:	1760605927
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JANET JACOBS LMFT

Provider Business Mailing Address
First Line	:	1915 PORT WEYBRIDGE PL
Second Line	:
City	:	NEWPORT BEACH
State	:	CA
Zip	:	92660-5432
Country	:	US
Telephone Number	:	949-476-1214
Fax Number	:	949-644-9426

Provider Business Practice Location Address
First Line	:	19742 MACARTHUR BLVD STE 145
Second Line	:
City	:	IRVINE
State	:	CA
Zip	:	92612-2430
Country	:	US
Telephone Number	:	949-476-1214
Fax Number	:	949-644-9426

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

Provider Enumeration Date	:	04/10/2007
Last Update Date	:	07/08/2007

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