Provider Demographics
NPI:1699477760
Name:MONKARSH, JACOB WILLIAM (MFT)
Entity type:Individual
Prefix:
First Name:JACOB
Middle Name:WILLIAM
Last Name:MONKARSH
Suffix:
Gender:M
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1552 HI POINT ST APT 7
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90035-3938
Mailing Address - Country:US
Mailing Address - Phone:310-488-0264
Mailing Address - Fax:
Practice Address - Street 1:1552 HI POINT ST APT 7
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90035-3938
Practice Address - Country:US
Practice Address - Phone:310-488-0264
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-21
Last Update Date:2023-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA123213106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty