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General NPI Number Information
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NPI Number | 1942931464
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Entity Type | Individual
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Provider Name | JESSICA NICOLE JACOB LMFT
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Gender | Female
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Dates
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Enumeration Date | 06/24/2022
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Last Update Date | 12/02/2024
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Provider Practice Location Address
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Address Line | 318 CEDAR ST STE 4
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City | ABILENE
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State | TX
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Zip | 79601-5722
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Country | US
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Telephone | 325-896-4174
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Fax |
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Provider Business Mailing Address
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Address Line | 608 FM 1770
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City | WINTERS
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State | TX
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Zip | 79567-7301
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Country | US
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Telephone | 325-320-3872
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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 | 204630
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License Number State | TX
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