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NPI Code Detail

MEDICARE: GREG JACOBS LICDC

MEDICARE: GREG JACOBS LICDC
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
1101YA0400XAddiction (Substance Use Disorder) Counselor892563OH

General Provider Information

NPI Number : 1114176039
Entity Type Code : Individual
Provider Name (Legal Business Name) : GREG JACOBS LICDC
Provider Business Mailing Address
First Line : 530 S MAIN ST
Second Line :
City : LIMA
State : OH
Zip : 45804-1240
Country : US
Telephone Number : 419-222-1168
Fax Number : 419-222-2158
Provider Business Practice Location Address
First Line : 530 S MAIN ST
Second Line :
City : LIMA
State : OH
Zip : 45804-1240
Country : US
Telephone Number : 419-222-1168
Fax Number : 419-222-2158
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/16/2008
Last Update Date : 05/13/2009

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Directions to “ GREG JACOBS LICDC” Practice Location

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