Healthcare Provider Details

I. General information

NPI: 1558712810
Provider Name (Legal Business Name): JACOB DANIEL ROSEN LMFT107103
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/28/2016
Last Update Date: 04/28/2026
Certification Date: 04/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7 COMMERCIAL ST
EUREKA CA
95501-0241
US

IV. Provider business mailing address

PO BOX 6912
EUREKA CA
95502-6912
US

V. Phone/Fax

Practice location:
  • Phone: 707-382-2445
  • Fax:
Mailing address:
  • Phone: 530-949-2884
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberLMFT107103
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLMFT107103
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: