MEDICARE: THYRA ANN JACOBS MA, ATR-BC, LPC

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	101YP2500X	Professional Counselor	PC015203	PA

General Provider Information

NPI Number	:	1205535044
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THYRA ANN JACOBS MA, ATR-BC, LPC

Provider Business Mailing Address
First Line	:	110 SENECA ST
Second Line	:
City	:	JOHNSTOWN
State	:	PA
Zip	:	15904-2428
Country	:	US
Telephone Number	:	412-720-7565
Fax Number	:

Provider Business Practice Location Address
First Line	:	716 CAMBRIA ST
Second Line	:
City	:	PORTAGE
State	:	PA
Zip	:	15946-1700
Country	:	US
Telephone Number	:	814-509-8110
Fax Number	:

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

Provider Enumeration Date	:	03/01/2023
Last Update Date	:	05/04/2024

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