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General NPI Number Information
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NPI Number | 1629530522
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Entity Type | Individual
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Provider Name | WARREN RUPERT JACOBS LMFT
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Gender | Male
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Dates
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Enumeration Date | 04/01/2019
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Last Update Date | 04/01/2019
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Provider Practice Location Address
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Address Line | 1063 14TH PL STE A
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City | DES MOINES
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State | IA
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Zip | 50314-1245
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Country | US
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Telephone | 515-235-5224
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Fax | 866-672-0706
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Provider Business Mailing Address
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Address Line | 314 E 5TH ST
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City | HUXLEY
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State | IA
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Zip | 50124-9465
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Country | US
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Telephone | 515-509-0219
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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 | 086474
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License Number State | IA
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