Healthcare Provider Details

I. General information

NPI: 1558880260
Provider Name (Legal Business Name): JACOB JOSEPH AND JABEZ FAMILY COUNSELING AND PROFESSIONAL SERVICES GRO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/13/2017
Last Update Date: 06/08/2023
Certification Date: 06/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

325 W HOSPITALITY LN STE 110
SAN BERNARDINO CA
92408-3210
US

IV. Provider business mailing address

2655 VILLA CREEK DR STE 201
FARMERS BRANCH TX
75234-7324
US

V. Phone/Fax

Practice location:
  • Phone: 909-332-7707
  • Fax: 951-823-5507
Mailing address:
  • Phone: 972-803-6950
  • Fax: 951-823-5507

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateNULL
# 5
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number StateNULL
# 6
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: DR. LA CENA LACHELLE JONES
Title or Position: CEO/ MARRIAGE FAMILY THERAPIST
Credential: LMFT
Phone: 310-213-0944