Thyra Ann Jacobs, MA, ATR-BC, LPC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

PC015203 Issued in PA

Practice address

716 Cambria St
Portage, PA 15946-1700

Phone

(814) 509-8110

NPI assigned

Mar 1, 2023

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other names 1

• Thyra Ann Berg Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Arts

State licenses

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

{
    "created_epoch": "1677628800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1714780800000",
    "number": "1205535044",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "110 SENECA ST",
            "city": "JOHNSTOWN",
            "state": "PA",
            "postal_code": "159042428",
            "telephone_number": "412-720-7565"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "716 CAMBRIA ST",
            "city": "PORTAGE",
            "state": "PA",
            "postal_code": "159461700",
            "telephone_number": "814-509-8110"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACOBS",
        "first_name": "THYRA",
        "middle_name": "ANN",
        "credential": "MA, ATR-BC, LPC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2023-03-01",
        "last_updated": "2024-05-04",
        "certification_date": "2024-05-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "PA",
            "license": "PC015203",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "THYRA",
            "last_name": "BERG",
            "middle_name": "ANN",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Professional Counselor in Portage, PA
• Providers in Portage, PA by specialty
• Professional Counselor in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 4, 2024; 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.