Individual
JACOB IREY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1662 MARS AVE, LAKEWOOD, OH 44107-3825
(216) 282-3838
Mailing address
1662 MARS AVE, LAKEWOOD, OH 44107-3825
(216) 282-3838
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
—
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0287342
—
OH
Enumeration date
05/11/2018
Last updated
02/11/2025
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