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General NPI Number Information
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NPI Number | 1215668587
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Entity Type | Individual
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Provider Name | HOLLY JACOBS LPC
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Gender | Female
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Dates
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Enumeration Date | 06/18/2022
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Last Update Date | 06/18/2022
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Provider Practice Location Address
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Address Line | 4650 MEXICO RD
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City | SAINT PETERS
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State | MO
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Zip | 63376-1607
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Country | US
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Telephone | 636-498-9326
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Fax |
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Provider Business Mailing Address
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Address Line | 2220 BEAM PL
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City | FLORISSANT
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State | MO
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Zip | 63031-8522
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Country | US
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Telephone | 636-498-9326
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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