Doctor Name: | MR. JAMIE JAKUBUS |
NPI Number: | 1164826327 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | M.A. |
License Number: | 6401014500 |
Business Practice Address: | 26300 Outer Dr Lincoln Park, MI - 481462019 |
Business Phone Number: | 7342723912 |
Business Fax Number: | 7342723912 |
Mailing Address: | 35549 Hazelwood St, WESTLAND |
State: | MI |
Postal Code: | 481864175 |
Phone Number: | 7345481764 |
Fax Number: | 7345481764 |
NPI Enumeration Date: | 10/17/2014 |
NPI Last Update Date: | 10/30/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YP2500X |
License Number: | 6401014500 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MI |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Professional |
Taxonomy Definition: |