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General NPI Number Information
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NPI Number | 1689285892
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Entity Type | Individual
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Provider Name | JACOB SANTHOUSE EDD, LCPC
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Gender | Male
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Dates
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Enumeration Date | 08/11/2020
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Last Update Date | 04/25/2025
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Provider Practice Location Address
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Address Line | 1700 66TH ST N # 104-312
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City | ST PETERSBURG
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State | FL
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Zip | 33710-5544
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Country | US
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Telephone | 312-883-4077
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Fax |
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Provider Business Mailing Address
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Address Line | 1700 66TH ST N # 104-312
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City | ST PETERSBURG
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State | FL
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Zip | 33710-5544
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Country | US
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Telephone | 312-883-4077
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | LPC.0017827
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 180013074
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 7778
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License Number State | ID
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Taxonomy #4
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | MH24041
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License Number State | FL
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