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General NPI Number Information
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NPI Number | 1942667076
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Entity Type | Individual
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Provider Name | JAMELL J JACOBS M.ED., NCC, PLPC
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Gender | Female
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Dates
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Enumeration Date | 01/20/2016
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Last Update Date | 01/20/2016
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Provider Practice Location Address
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Address Line | 111 CHURCH ST SUITE 103
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City | SAINT LOUIS
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State | MO
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Zip | 63135-2441
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Country | US
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Telephone | 314-485-7330
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Fax |
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Provider Business Mailing Address
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Address Line | 3609 THYME DR
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City | SAINT CHARLES
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State | MO
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Zip | 63303-6330
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Country | US
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Telephone | 310-766-9616
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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 | 2015043578
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License Number State | MO
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