Provider Demographics
NPI:1366896219
Name:PRICE, JACOB (LMHC)
Entity type:Individual
Prefix:
First Name:JACOB
Middle Name:
Last Name:PRICE
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:168 KENILWORTH RD
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32503-3319
Mailing Address - Country:US
Mailing Address - Phone:850-292-4032
Mailing Address - Fax:
Practice Address - Street 1:168 KENILWORTH RD
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32503-3319
Practice Address - Country:US
Practice Address - Phone:850-292-4032
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-18
Last Update Date:2016-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH13948101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health