Healthcare Provider Details

I. General information

NPI: 1225966211
Provider Name (Legal Business Name): LEAH JACOBS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2026
Last Update Date: 05/11/2026
Certification Date: 05/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6815 ISAACS ORCHARD RD STE C
SPRINGDALE AR
72762-6285
US

IV. Provider business mailing address

2389 E CAMELOT PL
FAYETTEVILLE AR
72701-2751
US

V. Phone/Fax

Practice location:
  • Phone: 501-416-8382
  • Fax:
Mailing address:
  • Phone: 501-416-8382
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberP2605005
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: