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General NPI Number Information
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NPI Number | 1134918899
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Entity Type | Individual
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Provider Name | JACOB BAXTER LMFT-A
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Gender | Male
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Dates
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Enumeration Date | 04/30/2025
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Last Update Date | 04/30/2025
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Provider Practice Location Address
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Address Line | 17043 EL CAMINO REAL STE 220
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City | HOUSTON
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State | TX
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Zip | 77058-2645
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Country | US
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Telephone | 936-931-8089
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Fax |
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Provider Business Mailing Address
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Address Line | 6310 VERDE PLACE LN
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City | KATY
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State | TX
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Zip | 77493-3084
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Country | US
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Telephone | 832-597-0589
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Fax |
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 205538
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License Number State | TX
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