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General NPI Number Information
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NPI Number | 1548005424
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Entity Type | Individual
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Provider Name | TYLER CHARLES JACOBS-LEWIS LMHC, LPCC, CCMHC
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Gender | Male
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Dates
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Enumeration Date | 07/01/2024
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Last Update Date | 11/14/2025
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Provider Practice Location Address
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Address Line | 2501 GRAND AVE
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City | DES MOINES
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State | IA
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Zip | 50312-5342
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Country | US
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Telephone | 515-344-3163
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Fax | 515-400-1119
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Provider Business Mailing Address
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Address Line | 1165 2ND AVE UNIT 8412
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City | DES MOINES
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State | IA
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Zip | 50301-8519
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Country | US
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Telephone | 515-344-3163
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Fax | 515-400-1119
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | T23093
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License Number State | IA
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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 | 5283
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License Number State | MN
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Taxonomy #3
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 111725
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License Number State | IA
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