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General NPI Number Information
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NPI Number | 1417628280
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Entity Type | Individual
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Provider Name | JACOB MOULIERT
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Gender | Male
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Dates
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Enumeration Date | 09/22/2021
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Last Update Date | 04/15/2025
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Provider Practice Location Address
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Address Line | 1817 OLDE HOMESTEAD LN
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City | LANCASTER
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State | PA
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Zip | 17601-6751
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Country | US
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Telephone | 223-275-3158
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Fax |
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Provider Business Mailing Address
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Address Line | 14 ROSELLE AVE
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City | LANCASTER
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State | PA
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Zip | 17603-6698
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Country | US
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Telephone | 609-432-3081
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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 | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | PC017036
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License Number State | PA
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