Healthcare Provider Details

I. General information

NPI: 1881470185
Provider Name (Legal Business Name): JULIA JACOBSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/04/2023
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

67 E WELDON AVE STE 310
PHOENIX AZ
85012-2045
US

IV. Provider business mailing address

2716 E FAIRMOUNT AVE
PHOENIX AZ
85016-6814
US

V. Phone/Fax

Practice location:
  • Phone: 480-338-0741
  • Fax:
Mailing address:
  • Phone: 480-338-0741
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPC-24713
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: