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General NPI Number Information
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NPI Number | 1427405158
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Entity Type | Individual
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Provider Name | JEAN JACOBSON MA, RMHCI
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Gender | Female
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Dates
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Enumeration Date | 05/23/2016
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Last Update Date | 11/01/2022
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Provider Practice Location Address
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Address Line | 640 BREVARD AVE
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City | COCOA
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State | FL
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Zip | 32922-7849
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Country | US
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Telephone | 321-312-9072
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Fax |
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Provider Business Mailing Address
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Address Line | 6751 FAWN RIDGE DR
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City | VIERA
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State | FL
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Zip | 32940-6822
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Country | US
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Telephone | 321-312-9072
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | MH16679
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License Number State | FL
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