Healthcare Provider Details

I. General information

NPI: 1134666985
Provider Name (Legal Business Name): JACOB STEVENS MA, PLPC, CMHT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/31/2017
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

302 S SPRING ST STE A
TUPELO MS
38804-4853
US

IV. Provider business mailing address

5327 WYNTREE CV
TUPELO MS
38801-8998
US

V. Phone/Fax

Practice location:
  • Phone: 662-205-0098
  • Fax:
Mailing address:
  • Phone: 662-200-7279
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberP-1347
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: