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General NPI Number Information
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NPI Number | 1801604764
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Entity Type | Individual
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Provider Name | NEICOO WALLACE JACOBY
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Gender | Female
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Dates
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Enumeration Date | 12/24/2024
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Last Update Date | 12/24/2024
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Provider Practice Location Address
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Address Line | 334 VIA VERA CRUZ STE 259
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City | SAN MARCOS
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State | CA
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Zip | 92078-2643
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Country | US
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Telephone | 760-683-5041
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Fax |
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Provider Business Mailing Address
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Address Line | 1248 SAN ELIJO RD N
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City | SAN MARCOS
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State | CA
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Zip | 92078-1086
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Country | US
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Telephone |
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 149619
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License Number State | CA
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