Healthcare Provider Details

I. General information

NPI: 1376995167
Provider Name (Legal Business Name): JACOB DAVID PERKINS LCSW, MSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2016
Last Update Date: 12/12/2025
Certification Date: 12/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 N GORE AVE
WEBSTER GROVES MO
63119-1600
US

IV. Provider business mailing address

12455 MARINE AVE
MARYLAND HEIGHTS MO
63043-3633
US

V. Phone/Fax

Practice location:
  • Phone: 844-424-3577
  • Fax:
Mailing address:
  • Phone: 314-379-8504
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number2021034284
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: