Lisa Jacobs Clark

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

IMF69558 Issued in CA

Practice address

6840 Indiana Ave Ste 275
Riverside, CA 92506

Phone

(951) 823-5134

NPI assigned

Sep 1, 2016

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

• Lisa Jacobs Clark Professional name

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": "1472688000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1472688000000",
    "number": "1891241469",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6840 INDIANA AVE STE 275",
            "city": "RIVERSIDE",
            "state": "CA",
            "postal_code": "925064279",
            "telephone_number": "951-778-0230"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6840 INDIANA AVE STE 275",
            "city": "RIVERSIDE",
            "state": "CA",
            "postal_code": "92506",
            "telephone_number": "951-823-5134"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACOBS CLARK",
        "first_name": "LISA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2016-09-01",
        "last_updated": "2016-09-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "CA",
            "license": "IMF69558",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "LISA",
            "last_name": "JACOBS CLARK",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• Tyron Jackson
• Wilson Jackson
• Diana Jacob
• Crystal S Jacobo
• Linda Jacobo
• Desiree Besas Jacobs, LCSW
• Elizabeth A Jacobs, MD
• Fernando Honorio Jacobs, D.D.S.
• Myeisha Jacobs
• Deann Marie Jacobsen, MS, PTA, ATC

• Mental Health Counselor in Riverside, CA
• Providers in Riverside, CA by specialty
• Mental Health Counselor in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 1, 2016; 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.