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General NPI Number Information
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NPI Number | 1710855606
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Entity Type | Individual
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Provider Name | JAKE THOMAS ACOSTA
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Gender |
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Dates
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Enumeration Date | 10/23/2025
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Last Update Date | 10/24/2025
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Provider Practice Location Address
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Address Line | 2323 N MOORPARK RD
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City | THOUSAND OAKS
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State | CA
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Zip | 91360-3101
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Country | US
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Telephone | 805-495-7491
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Fax |
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Provider Business Mailing Address
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Address Line | 3268 RADCLIFFE RD
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City | THOUSAND OAKS
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State | CA
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Zip | 91360-4621
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Country | US
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Telephone | 805-857-4193
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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 | 158665
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License Number State | CA
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