Organization
AMY M.JACOBS, LLC
Active
Organization
AMY M.JACOBS, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
AMY M. JACOBS LCP (LICENSED CLINICAL PSYCHOTHERAPIST)
(316) 636-1188
Entity
Organization
Contact information
Practice address
7807 E FUNSTON ST, WICHITA, KS 67207-3123
(316) 636-1188
Mailing address
7807 E FUNSTON ST, WICHITA, KS 67207-3123
(316) 636-1188
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
188
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1154303659
INDIVIDUAL NPI
KS
Enumeration date
05/04/2012
Last updated
05/04/2012
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