Individual
MRS. LAUREN BETTY JACOB
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MA, TLLP
Contact information
Practice address
2351 W. 12 MILE RD., BERKLEY, MI 48072-1826
(248) 544-4004
(248) 544-4113
Mailing address
2351 W. 12 MILE RD., BERKLEY, MI 48072-1826
(248) 544-4004
(248) 544-4113
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
6301015300
MI
103TC0700X
Clinical Psychologist
L2310588
MI
Other
Enumeration date
04/17/2013
Last updated
06/01/2016
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