Provider Demographics
NPI:1053590760
Name:JACOBS, GAIL JEAN (LCSW)
Entity type:Individual
Prefix:MRS
First Name:GAIL
Middle Name:JEAN
Last Name:JACOBS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:660 STONES THROW RD
Mailing Address - Street 2:
Mailing Address - City:GARDNERVILLE
Mailing Address - State:NV
Mailing Address - Zip Code:89410-7809
Mailing Address - Country:US
Mailing Address - Phone:775-781-9916
Mailing Address - Fax:
Practice Address - Street 1:1650 HWY 395 SUITE 202C
Practice Address - Street 2:
Practice Address - City:MINDEN
Practice Address - State:NV
Practice Address - Zip Code:89423
Practice Address - Country:US
Practice Address - Phone:775-781-9916
Practice Address - Fax:775-265-1841
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-30
Last Update Date:2020-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA175331041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV7800-COtherLCSW
CA17533OtherLCSW