| Doctor Name: | MR. RANDALL GLEN JACOBS |
| NPI Number: | 1114079811 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | LCSW |
| License Number: | LCS21308 |
| Business Practice Address: | 1662 Us Highway 395 N Suite 209 Minden, NV - 894234329 |
| Business Phone Number: | 7757819767 |
| Business Fax Number: | 7752651841 |
| Mailing Address: | 1662 Us Highway 395 N, Suite 209 MINDEN |
| State: | NV |
| Postal Code: | 894234329 |
| Phone Number: | 7757819767 |
| Fax Number: | 7752651841 |
| NPI Enumeration Date: | 01/16/2007 |
| NPI Last Update Date: | 03/10/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1041C0700X |
| License Number: | LCS21308 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | CA |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Social Worker |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | A social worker who holds a master |