Provider Demographics
NPI:1033665716
Name:JACOBSON, TERESA (DBH, LPCC, NCC)
Entity type:Individual
Prefix:DR
First Name:TERESA
Middle Name:
Last Name:JACOBSON
Suffix:
Gender:F
Credentials:DBH, LPCC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 MARKET PLACE CIR STE C-182
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:KY
Mailing Address - Zip Code:40324-7205
Mailing Address - Country:US
Mailing Address - Phone:513-206-3026
Mailing Address - Fax:513-620-5642
Practice Address - Street 1:124 HICKORY GROVE CT
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:KY
Practice Address - Zip Code:40324-2177
Practice Address - Country:US
Practice Address - Phone:513-206-3026
Practice Address - Fax:513-620-5642
Is Sole Proprietor?:No
Enumeration Date:2016-08-31
Last Update Date:2025-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY275437101YP2500X
OHE.1200234101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional