Healthcare Provider Details

I. General information

NPI: 1063322667
Provider Name (Legal Business Name): PAUL JACOBSON MFT, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/08/2026
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

535 MAIN ST
AMES IA
50010-6067
US

IV. Provider business mailing address

100 CHRISTIAN PETERSEN AVE
GILBERT IA
50105-1018
US

V. Phone/Fax

Practice location:
  • Phone: 515-854-3699
  • Fax:
Mailing address:
  • Phone: 515-708-6575
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: PAUL JAMES JACOBSON
Title or Position: MARRIAGE AND FAMILY THERAPIST
Credential: LMFT
Phone: 515-708-6575