=====================================================
General NPI Number Information
=====================================================
NPI Number | 1619876497
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CARLY JACOBS LICENSED CLINICAL SOCIAL WORKER, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/05/2026
-----------------------------------------------------
Last Update Date | 11/05/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3179 BECHELLI LN STE 210
-----------------------------------------------------
City | REDDING
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 96002-2041
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 530-641-9087
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3179 BECHELLI LN STE 210
-----------------------------------------------------
City | REDDING
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 96002-2041
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 530-641-9087
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | LCSW/OWNER
-----------------------------------------------------
Name | CARLY PATRICIA HARMONY JACOBS-RUEBER
-----------------------------------------------------
Credential | LCSW
-----------------------------------------------------
Telephone | 530-641-9087
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251S00000X
-----------------------------------------------------
Taxonomy Name | Community/Behavioral Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------