Healthcare Provider Details

I. General information

NPI: 1982921417
Provider Name (Legal Business Name): JACOB FELIX SPENCER PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/23/2010
Last Update Date: 05/26/2025
Certification Date: 05/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

326 I ST # 108
EUREKA CA
95501-0522
US

IV. Provider business mailing address

326 I ST # 108
EUREKA CA
95501-0522
US

V. Phone/Fax

Practice location:
  • Phone: 530-310-7818
  • Fax:
Mailing address:
  • Phone: 530-310-7818
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY27901
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: