Provider Demographics
NPI:1588787188
Name:JACOBS, TOM (LCPC)
Entity type:Individual
Prefix:
First Name:TOM
Middle Name:
Last Name:JACOBS
Suffix:
Gender:M
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 N CLARK ST
Mailing Address - Street 2:SUITE 2650
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60602-4109
Mailing Address - Country:US
Mailing Address - Phone:866-296-5262
Mailing Address - Fax:312-558-1570
Practice Address - Street 1:3759 W 95TH ST
Practice Address - Street 2:SUITE 3
Practice Address - City:EVERGREEN PARK
Practice Address - State:IL
Practice Address - Zip Code:60805-2000
Practice Address - Country:US
Practice Address - Phone:866-296-5262
Practice Address - Fax:312-558-1570
Is Sole Proprietor?:No
Enumeration Date:2007-04-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health