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General NPI Number Information
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NPI Number | 1316776818
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Entity Type | Organization
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Legal Business Name | JACOBSON COMMUNITY MENTAL HEALTH AND WELLNESS PLLC
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Dates
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Enumeration Date | 07/31/2024
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Last Update Date | 09/26/2024
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Provider Practice Location Address
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Address Line | 11900 NE 1ST ST STE 300
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City | BELLEVUE
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State | WA
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Zip | 98005-3049
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Country | US
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Telephone | 818-913-2075
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Fax |
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Provider Business Mailing Address
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Address Line | 14110 NE 21ST ST APT 1095
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City | BELLEVUE
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State | WA
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Zip | 98007-3719
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Country | US
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Telephone | 818-913-2075
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | HOLLY L. JACOBSON
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Credential | PMHNP
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Telephone | 818-913-2075
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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