Healthcare Provider Details

I. General information

NPI: 1619876497
Provider Name (Legal Business Name): CARLY JACOBS LICENSED CLINICAL SOCIAL WORKER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

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

III. Provider practice location address

3179 BECHELLI LN STE 210
REDDING CA
96002-2041
US

IV. Provider business mailing address

3179 BECHELLI LN STE 210
REDDING CA
96002-2041
US

V. Phone/Fax

Practice location:
  • Phone: 530-641-9087
  • Fax:
Mailing address:
  • Phone: 530-641-9087
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: CARLY PATRICIA HARMONY JACOBS-RUEBER
Title or Position: LCSW/OWNER
Credential: LCSW
Phone: 530-641-9087