Active NPI
Brian Jacobsen, RMHCI
- Mental Health Counselor
- Bartow, FL
National Provider Identifier
1982955654
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- IMH16673
- Practice address
- 1255 Golfview Ave
Bartow, FL 33830-6736 - Phone
- (863) 519-0575
- NPI assigned
- Sep 21, 2012
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | IMH16673 | FL | Primary |
Addresses
Primary practice location
1255 Golfview Ave
Bartow, FL 33830-6736
Mailing address
PO Box 1559
Bartow, FL 33831-1559
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| IMH16673 | FL | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1348185600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1523318400000",
"number": "1982955654",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 1559",
"city": "BARTOW",
"state": "FL",
"postal_code": "338311559"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1255 GOLFVIEW AVE",
"city": "BARTOW",
"state": "FL",
"postal_code": "338306736",
"telephone_number": "863-519-0575"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACOBSEN",
"first_name": "BRIAN",
"credential": "RMHCI",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2012-09-21",
"last_updated": "2018-04-10",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "FL",
"license": "IMH16673",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bartow, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 10, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.