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General NPI Number Information
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NPI Number | 1871624494
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Entity Type | Individual
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Provider Name | COURTNEY ANNE JACOBS PH.D.
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Gender | Female
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Dates
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Enumeration Date | 03/07/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 16055 VENTURA BLVD SUITE 828
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City | ENCINO
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State | CA
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Zip | 91436-2601
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Country | US
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Telephone | 818-382-1998
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Fax | 661-296-1581
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Provider Business Mailing Address
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Address Line | 16055 VENTURA BLVD SUITE 828
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City | ENCINO
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State | CA
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Zip | 91436-2601
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Country | US
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Telephone | 818-382-1998
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Fax | 661-296-1581
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PSY14573
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License Number State | CA
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