Individual
CORAL JACOBSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PLPC
Contact information
Practice address
501 S 36TH ST STE 102, SAINT JOSEPH, MO 64506-3067
(816) 396-6002
Mailing address
1106 N 155TH ST STE B, BASEHOR, KS 66007-7100
(913) 662-7071
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
2021022398
MO
103TF0000X
Family Psychologist
2848
KS
171M00000X
Case Manager/Care Coordinator
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2021022398
PROFESSIONAL COUNSELING
MO
Enumeration date
03/29/2016
Last updated
07/28/2021
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