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General NPI Number Information
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NPI Number | 1144594466
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Entity Type | Individual
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Provider Name | JUDY LYNN JACOBS PHD
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Gender | Female
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Dates
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Enumeration Date | 03/05/2012
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Last Update Date | 06/07/2024
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Provider Practice Location Address
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Address Line | 43157 SCHOENHERR RD
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City | STERLING HEIGHTS
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State | MI
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Zip | 48313
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Country | US
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Telephone | 248-310-5973
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Fax | 248-731-7388
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Provider Business Mailing Address
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Address Line | 41428 GREENSPIRE DR
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City | CLINTON TWP
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State | MI
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Zip | 48038-5863
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Country | US
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Telephone | 248-310-5973
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Fax | 248-731-7388
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 6401012194
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License Number State | MI
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