Basic Information
| Provider Information | |||||||||
| NPI: | 1740446020 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JACOBS | ||||||||
| FirstName: | DARREN | ||||||||
| MiddleName: | E | ||||||||
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| NameSuffix: | SR. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4588 N RANCHO DR | ||||||||
| Address2: | 12 | ||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891303426 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7023963464 | ||||||||
| FaxNumber: | 7023966164 | ||||||||
| Practice Location | |||||||||
| Address1: | 315 S 7TH ST | ||||||||
| Address2: | |||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891015801 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7027997800 | ||||||||
| FaxNumber: | 7027991600 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/05/2008 | ||||||||
| LastUpdateDate: | 11/01/2010 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YS0200X | 74303 | NV | Y | Behavioral Health & Social Service Providers | Counselor | School | 172V00000X | N | Other Service Providers | Community Health Worker |
No ID Information.