Provider Demographics
NPI:1154896819
Name:JACOBSON, GRAAL BAIOCCHI (MA, LPC)
Entity type:Individual
Prefix:MRS
First Name:GRAAL
Middle Name:BAIOCCHI
Last Name:JACOBSON
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16211 VIKI LYNN PL
Mailing Address - Street 2:
Mailing Address - City:PFLUGERVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78660-2015
Mailing Address - Country:US
Mailing Address - Phone:512-786-5065
Mailing Address - Fax:
Practice Address - Street 1:2525 WALLINGWOOD DR BLDG 13
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78746-6900
Practice Address - Country:US
Practice Address - Phone:512-587-4415
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-09
Last Update Date:2018-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX65408101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional