Healthcare Provider Details

I. General information

NPI: 1457270639
Provider Name (Legal Business Name): JACOB ALBERT AMFT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2026
Last Update Date: 07/13/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6116 LA SALLE AVE # 205
OAKLAND CA
94611-2802
US

IV. Provider business mailing address

5176 GOLDEN GATE AVE
OAKLAND CA
94618-2043
US

V. Phone/Fax

Practice location:
  • Phone: 510-761-6374
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberAMFT159980
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: