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General NPI Number Information
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NPI Number | 1619918430
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Entity Type | Individual
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Provider Name | WILLIAM JACOBS L.P.C.C.
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Gender | Male
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Dates
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Enumeration Date | 06/10/2006
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Last Update Date | 09/30/2009
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Provider Practice Location Address
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Address Line | 1127 ALAMEDA BLVD NW STE C
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City | ALBUQUERQUE
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State | NM
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Zip | 87114-1240
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Country | US
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Telephone | 505-379-0810
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Fax | 520-201-0179
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Provider Business Mailing Address
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Address Line | 8608 CLARIDGE PL NW
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City | ALBUQUERQUE
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State | NM
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Zip | 87114-6209
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Country | US
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Telephone | 505-379-0810
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Fax | 520-203-0179
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 0065602
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License Number State | NM
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