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General NPI Number Information
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NPI Number | 1730889817
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Entity Type | Organization
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Legal Business Name | JACOBS PSYCHOLOGICAL SERVICES, PC
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Dates
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Enumeration Date | 03/07/2023
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Last Update Date | 03/26/2023
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Provider Practice Location Address
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Address Line | 12304 SANTA MONICA BLVD # 315
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City | LOS ANGELES
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State | CA
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Zip | 90025-2551
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Country | US
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Telephone | 818-571-2285
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Fax | 323-272-4076
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Provider Business Mailing Address
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Address Line | 16350 VENTURA BLVD # D147
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City | ENCINO
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State | CA
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Zip | 91436-5300
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Country | US
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Telephone | 818-571-2285
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Fax | 323-272-4076
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Authorized Official
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Title or Position | CLINICAL DIRECTOR
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Name | DR. JOSEPH D JACOBS
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Credential | PHD
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Telephone | 818-571-2285
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State |
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