Jacobson Community Mental Health and Wellness PLLC

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

Legal business name

JACOBSON COMMUNITY MENTAL HEALTH AND WELLNESS PLLC

Practice address

11900 NE 1St St Ste 300
Bellevue, WA 98005-3049

Phone

(818) 913-2075

NPI assigned

Jul 31, 2024

Organization subpart

No

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

Authorized official

Name

Holly L. Jacobson, PMHNPNPI 1861073322

Title

Ceo

Phone

(818) 913-2075

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA, WA2 enrollments

Enrollment records 2

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Holly Jacobson, PMHNP

  • Psychiatric/Mental Health Nurse Practitioner
  • Moorpark, CA
  • NPI 1861073322

  Single Specialty, WA

  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1722384000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1727308800000",
    "number": "1316776818",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14110 NE 21ST ST APT 1095",
            "city": "BELLEVUE",
            "state": "WA",
            "postal_code": "980073719",
            "telephone_number": "818-913-2075"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11900 NE 1ST ST STE 300",
            "city": "BELLEVUE",
            "state": "WA",
            "postal_code": "980053049",
            "telephone_number": "818-913-2075"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JACOBSON COMMUNITY MENTAL HEALTH AND WELLNESS PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-07-31",
        "last_updated": "2024-09-26",
        "certification_date": "2024-09-26",
        "status": "A",
        "authorized_official_last_name": "JACOBSON",
        "authorized_official_first_name": "HOLLY",
        "authorized_official_middle_name": "L.",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "818-913-2075",
        "authorized_official_credential": "PMHNP"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Richard S Jacobs, PHARMD
• Teresa E. Jacobs, M.D.
• William Jacobs, LMP
• Emily C Jacobsen, CPHT
• Karen Jacobsen, THERAPIST
• Hanna Jacobson, OTR/L
• Jade Oasis PLLC
• Kaya Jaecks
• Ashlyn Nicole Jaeger, PT, DPT
• Marcus Jaffe, D.P.T.

• Psychiatric/Mental Health Nurse Practitioner in Bellevue, WA
• Providers in Bellevue, WA by specialty
• Psychiatric/Mental Health Nurse Practitioner in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 26, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.