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NPI Code Detail

MEDICARE: MR. PETER JACOBSON

MEDICARE: MR. PETER JACOBSON
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
1101YM0800XMental Health Counselor

General Provider Information

NPI Number : 1114190246
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. PETER JACOBSON
Provider Business Mailing Address
First Line : 3715 E I ST
Second Line :
City : TACOMA
State : WA
Zip : 98404-3031
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 610 YAKIMA AVE
Second Line :
City : TACOMA
State : WA
Zip : 98405-4851
Country : US
Telephone Number : 253-396-5230
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/09/2008
Last Update Date : 04/09/2008

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Directions to “ MR. PETER JACOBSON ” Practice Location

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