=====================================================
General NPI Number Information
=====================================================
NPI Number | 1326788753
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JAMI LYNN JACOBSON LMHC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/01/2022
-----------------------------------------------------
Last Update Date | 04/01/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1517 DEKALB AVE APT 3R
-----------------------------------------------------
City | BROOKLYN
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11237-3637
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 406-212-0767
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1517 DEKALB AVE APT 3R
-----------------------------------------------------
City | BROOKLYN
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11237-3637
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 406-212-0767
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number | 012191-01
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------