Provider Demographics
NPI:1457422297
Name:JACOBS, MERRI LEE (PHD)
Entity type:Individual
Prefix:
First Name:MERRI LEE
Middle Name:
Last Name:JACOBS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:543 MAIN ST
Mailing Address - Street 2:SUITE 105
Mailing Address - City:EDMONDS
Mailing Address - State:WA
Mailing Address - Zip Code:98020-3162
Mailing Address - Country:US
Mailing Address - Phone:206-546-0805
Mailing Address - Fax:206-542-5893
Practice Address - Street 1:543 MAIN ST
Practice Address - Street 2:SUITE 105
Practice Address - City:EDMONDS
Practice Address - State:WA
Practice Address - Zip Code:98020-3162
Practice Address - Country:US
Practice Address - Phone:206-546-0805
Practice Address - Fax:206-542-5893
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY00001429103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling