Provider Demographics
NPI:1689789190
Name:JACOBS, HELENE BETH (PH D)
Entity type:Individual
Prefix:
First Name:HELENE
Middle Name:BETH
Last Name:JACOBS
Suffix:
Gender:F
Credentials:PH D
Other - Prefix:
Other - First Name:H
Other - Middle Name:BETH
Other - Last Name:JACOBS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PH D
Mailing Address - Street 1:1903 OXMOOR ROAD
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35209
Mailing Address - Country:US
Mailing Address - Phone:205-879-3778
Mailing Address - Fax:205-874-7060
Practice Address - Street 1:1903 OXMOOR ROAD
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35209
Practice Address - Country:US
Practice Address - Phone:205-879-3778
Practice Address - Fax:205-874-7060
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL441103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
R37147Medicare UPIN