Provider Demographics
NPI:1063750404
Name:DEFEE, JACOB A (LPC)
Entity type:Individual
Prefix:
First Name:JACOB
Middle Name:A
Last Name:DEFEE
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:317 OAK ST STE 3
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:AR
Mailing Address - Zip Code:72032-5679
Mailing Address - Country:US
Mailing Address - Phone:501-291-3091
Mailing Address - Fax:
Practice Address - Street 1:100 W GROVE ST STE 302
Practice Address - Street 2:
Practice Address - City:EL DORADO
Practice Address - State:AR
Practice Address - Zip Code:71730-4669
Practice Address - Country:US
Practice Address - Phone:501-358-6396
Practice Address - Fax:501-588-0484
Is Sole Proprietor?:No
Enumeration Date:2013-01-18
Last Update Date:2023-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARP1701219101YP2500X
171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No171M00000XOther Service ProvidersCase Manager/Care Coordinator