Provider Demographics
NPI:1306311931
Name:JAKUB, CHRISTOPHER RICHARD SR (LPCC, LMHC)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:RICHARD
Last Name:JAKUB
Suffix:SR
Gender:M
Credentials:LPCC, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:303 NE 3RD AVE STE 8
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33909-2538
Mailing Address - Country:US
Mailing Address - Phone:239-799-2198
Mailing Address - Fax:239-354-7234
Practice Address - Street 1:303 NE 3RD AVE
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33909-2538
Practice Address - Country:US
Practice Address - Phone:239-799-2198
Practice Address - Fax:239-354-7234
Is Sole Proprietor?:No
Enumeration Date:2018-10-10
Last Update Date:2023-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE2001805101YM0800X
FLMH19081101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty