Individual
JAY D JACOBS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
105 CANYON LAKE CIR, LUMBERTON, TX 77657-3701
(409) 200-2220
Mailing address
215 RUSTIC LN, LUMBERTON, TX 77657-6907
(409) 549-3326
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
96392
TX
Other
Enumeration date
09/09/2024
Last updated
09/09/2024
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