| NPI | 1326605262 |
|---|---|
| Former Name | SCOTT RISKIE JACOBS |
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: FL IMH15710) |
| Enumeration Date | 2019-05-28 |
| Last Update Date | 2019-05-28 |