| Doctor Name: | DR. KELLY B JACOBSON |
| NPI Number: | 1023231032 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | PH.D. |
| License Number: | PY 0007292 |
| Business Practice Address: | 1850 Lee Rd Suite 234 Winter Park, FL - 327892115 |
| Business Phone Number: | 4076780100 |
| Business Fax Number: | |
| Mailing Address: | 1850 Lee Rd, Suite 234 WINTER PARK |
| State: | FL |
| Postal Code: | 327892115 |
| Phone Number: | 4076780100 |
| Fax Number: | |
| NPI Enumeration Date: | 04/10/2007 |
| NPI Last Update Date: | 09/01/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TC1900X |
| License Number: | PY 0007292 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | FL |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Counseling |
| Taxonomy Definition: | |