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NPI Code Detail

MEDICARE: MR. CLIFFORD LOREN JACOBSON JR. MFT

MEDICARE:  MR. CLIFFORD LOREN JACOBSON JR. MFT
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
1106H00000XMarriage & Family TherapistLMFT79264CA

General Provider Information

NPI Number : 1356533285
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. CLIFFORD LOREN JACOBSON JR. MFT
Provider Business Mailing Address
First Line : 578 RIO LINDO AVE
Second Line :
City : CHICO
State : CA
Zip : 95926-1800
Country : US
Telephone Number : 530-894-5933
Fax Number : 530-894-5791
Provider Business Practice Location Address
First Line : 578 RIO LINDO AVE
Second Line :
City : CHICO
State : CA
Zip : 95926-1800
Country : US
Telephone Number : 530-894-5933
Fax Number : 530-894-5791
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/14/2007
Last Update Date : 03/12/2014

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Directions to “ MR. CLIFFORD LOREN JACOBSON JR. MFT” Practice Location

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