Jacob Rundall, LCSW

Primary specialty

Social WorkerTaxonomy code 104100000X

License

LCSW-21992 Issued in AZ

Practice address

3231 W Shangri la Rd
Phoenix, AZ 85029-4151

Phone

(563) 639-4787

NPI assigned

Mar 2, 2021

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: jacob.rundall@489656322949124.direct.elationemr.com

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Jus Lee Counseling Group LLC

  • Community/Behavioral Health Agency
  • Phoenix, AZ
  • NPI 1689485328
  NPD Authorized official
• Pathway to Peace Psychotherapy PLLC

  • Mental Health Counselor
  • Phoenix, AZ
  • NPI 1710683289
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1614643200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1773187200000",
    "number": "1205421229",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3231 W SHANGRI LA RD",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850294151",
            "telephone_number": "636-394-7875"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3231 W SHANGRI LA RD",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850294151",
            "telephone_number": "563-639-4787"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUNDALL",
        "first_name": "JACOB",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-03-02",
        "last_updated": "2026-03-11",
        "certification_date": "2026-03-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "NM",
            "license": "SWB-2024-0480",
            "primary": false
        },
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "AZ",
            "license": "LCSW-21992",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Susan Marie Rumble, PSY.D.
• Allene D Rummage, DC
• James Rumph
• Run It Back Behavioral Therapy LLC
• Craig Runbeck, NMD
• Graciela Brige Rundle, NMD
• Pamela Runfola, MD
• Cheryl A Runge, M.S.,CCC-A
• Julia Mariah Runkle, MS OTR/L
• Clifford H. Running, D.D.S.

• Social Worker in Phoenix, AZ
• Providers in Phoenix, AZ by specialty
• Social Worker in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 11, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.