Provider Demographics
NPI:1215668587
Name:JACOBS, HOLLY (LPC)
Entity type:Individual
Prefix:
First Name:HOLLY
Middle Name:
Last Name:JACOBS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2220 BEAM PL
Mailing Address - Street 2:
Mailing Address - City:FLORISSANT
Mailing Address - State:MO
Mailing Address - Zip Code:63031-8522
Mailing Address - Country:US
Mailing Address - Phone:636-498-9326
Mailing Address - Fax:
Practice Address - Street 1:4650 MEXICO RD
Practice Address - Street 2:
Practice Address - City:SAINT PETERS
Practice Address - State:MO
Practice Address - Zip Code:63376-1607
Practice Address - Country:US
Practice Address - Phone:636-498-9326
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-18
Last Update Date:2022-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional