Individual
KATIE LYNNE JACOBY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
960 W STATE ST, ALLIANCE, OH 44601-4685
(330) 771-9999
Mailing address
728 MCDANIEL AVE, MINERVA, OH 44657-1238
(330) 771-7034
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
LCDCIII.161912
OH
101YM0800X
Mental Health Counselor
Primary
C2103116
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
414018
—
OH
Enumeration date
07/21/2017
Last updated
08/19/2022
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