MEDICARE: RACHAEL JACOBS MFTC,LPCC

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	LPCC.0021864	CO
2	106H00000X	Marriage & Family Therapist	MFTC.0014650	CO

General Provider Information

NPI Number	:	1578384343
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RACHAEL JACOBS MFTC,LPCC

Provider Business Mailing Address
First Line	:	1312 17TH ST # 888
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80202-1508
Country	:	US
Telephone Number	:	303-717-0229
Fax Number	:

Provider Business Practice Location Address
First Line	:	3841 1/2 W 39TH AVE
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80211-1907
Country	:	US
Telephone Number	:	303-717-0229
Fax Number	:

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

Provider Enumeration Date	:	10/23/2024
Last Update Date	:	10/23/2024

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