Individual
MR. JEROME JACOB JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
315 S COLLEGE RD STE 220, LAFAYETTE, LA 70503
(337) 380-8947
Mailing address
PHOENIX FAMILY LIFE CENTERS, 100 ASMA BLVD, SUITE 200,, PHOENIX FAMILY LIFE CENTERS, 100 ASMA BLVD, SUITE 200,, LAFAYETTE, LA 70503-3221
(337) 380-8947
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
006065417
LA
Other
Enumeration date
11/10/2015
Last updated
05/21/2018
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