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General NPI Number Information
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NPI Number | 1053495150
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Entity Type | Individual
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Provider Name | EMILY MCCLINTIC JACOBS LCSW
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Gender | Female
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Dates
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Enumeration Date | 10/25/2006
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Last Update Date | 06/03/2011
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Provider Practice Location Address
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Address Line | 10 B VISTA DEL LAGO SUITE #3
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City | VALLEY SPRINGS
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State | CA
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Zip | 95252
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Country | US
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Telephone | 209-304-2924
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Fax | 209-772-2094
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Provider Business Mailing Address
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Address Line | PO 973 SAN ANDREAS
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City | SAN ANDREAS
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State | CA
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Zip | 95249
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Country | US
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Telephone | 209-304-2924
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Fax | 209-772-2094
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 9514
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | LCS9514
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License Number State | CA
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