Individual
MRS. LYNN MARIE JACOBS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS LLP
Contact information
Practice address
618 E 11 MILE RD, ROYAL OAK, MI 48067-1962
(248) 607-0793
Mailing address
E. 11 MILE RD, ROYAL OAK, MI 48067
(248) 607-0793
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
6301014502
MI
103TC0700X
Clinical Psychologist
Primary
6301014502
MI
103TC2200X
Clinical Child & Adolescent Psychologist
6301014502
MI
Other
Enumeration date
06/24/2011
Last updated
09/21/2016
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