MEDICARE: JAMELL J JACOBS M.ED., NCC, PLPC

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	2015043578	MO

General Provider Information

NPI Number	:	1942667076
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMELL J JACOBS M.ED., NCC, PLPC

Provider Business Mailing Address
First Line	:	3609 THYME DR
Second Line	:
City	:	SAINT CHARLES
State	:	MO
Zip	:	63303-6330
Country	:	US
Telephone Number	:	310-766-9616
Fax Number	:

Provider Business Practice Location Address
First Line	:	111 CHURCH ST
Second Line	:	SUITE 103
City	:	SAINT LOUIS
State	:	MO
Zip	:	63135-2441
Country	:	US
Telephone Number	:	314-485-7330
Fax Number	:

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

Provider Enumeration Date	:	01/20/2016
Last Update Date	:	01/20/2016

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