MEDICARE: MR. ALAN MICHAEL JACOBSON MA, LPC, LMFT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	4884	TX

General Provider Information

NPI Number	:	1114015609
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ALAN MICHAEL JACOBSON MA, LPC, LMFT

Provider Business Mailing Address
First Line	:	3400 BISSONNET
Second Line	:	SUITE 270
City	:	HOUSTON
State	:	TX
Zip	:	77005-2192
Country	:	US
Telephone Number	:	713-908-1944
Fax Number	:	713-668-6595

Provider Business Practice Location Address
First Line	:	3400 BISSONNET
Second Line	:	SUITE 270
City	:	HOUSTON
State	:	TX
Zip	:	77005-2192
Country	:	US
Telephone Number	:	713-908-1944
Fax Number	:	713-668-6595

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/10/2006
Last Update Date	:	07/08/2007

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