Fred Henry Jacobs

Primary specialty

CounselorTaxonomy code 101Y00000X

License

37PC00907900 Issued in NJ

Practice address

493 Beverly Rancocas Rd
Willingboro, NJ 08046-3517

Phone

(609) 543-9311

NPI assigned

Dec 21, 2022

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1671580800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1671580800000",
    "number": "1831801844",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "627 BARBADOS DR",
            "city": "WILLIAMSTOWN",
            "state": "NJ",
            "postal_code": "080943002",
            "telephone_number": "856-278-1904"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "493 BEVERLY RANCOCAS RD",
            "city": "WILLINGBORO",
            "state": "NJ",
            "postal_code": "080463517",
            "telephone_number": "609-543-9311"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACOBS",
        "first_name": "FRED",
        "middle_name": "HENRY",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-12-21",
        "last_updated": "2022-12-21",
        "certification_date": "2022-12-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": "NJ",
            "license": "37PC00907900",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "fjacobs@anewchristiancounseling.com",
            "affiliation": "N",
            "endpointDescription": "provider email",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "fjacobs1904@gmail.com",
            "address_1": "493 Beverly Rancocas Rd",
            "city": "Willingboro",
            "state": "NJ",
            "country_code": "US",
            "postal_code": "080463517",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Counselor in Willingboro, NJ
• Providers in Willingboro, NJ by specialty
• Counselor in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 21, 2022; 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.