Provider Demographics
NPI:1679089494
Name:JACOBUS, ASHLEY GRACE (LPC)
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:GRACE
Last Name:JACOBUS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:ASHLEY
Other - Middle Name:GRACE
Other - Last Name:GOTTFRIED
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1640 TIFFIN AVE STE B
Mailing Address - Street 2:
Mailing Address - City:FINDLAY
Mailing Address - State:OH
Mailing Address - Zip Code:45840-6849
Mailing Address - Country:US
Mailing Address - Phone:419-419-8500
Mailing Address - Fax:567-294-4902
Practice Address - Street 1:1640 TIFFIN AVE STE B
Practice Address - Street 2:
Practice Address - City:FINDLAY
Practice Address - State:OH
Practice Address - Zip Code:45840-6849
Practice Address - Country:US
Practice Address - Phone:419-419-8500
Practice Address - Fax:567-294-4902
Is Sole Proprietor?:No
Enumeration Date:2017-12-15
Last Update Date:2017-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC.1700736101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health