MEDICARE: CHRISTOPHER RICHARD JAKUB SR. LPCC, LMHC

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	101YM0800X	Mental Health Counselor	E2001805	OH
2	101YM0800X	Mental Health Counselor	MH19081	FL

General Provider Information

NPI Number	:	1306311931
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTOPHER RICHARD JAKUB SR. LPCC, LMHC

Provider Business Mailing Address
First Line	:	303 NE 3RD AVE STE 8
Second Line	:
City	:	CAPE CORAL
State	:	FL
Zip	:	33909-2538
Country	:	US
Telephone Number	:	239-799-2198
Fax Number	:	239-354-7234

Provider Business Practice Location Address
First Line	:	303 NE 3RD AVE
Second Line	:
City	:	CAPE CORAL
State	:	FL
Zip	:	33909-2538
Country	:	US
Telephone Number	:	239-799-2198
Fax Number	:	239-354-7234

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

Provider Enumeration Date	:	10/10/2018
Last Update Date	:	10/26/2023

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