Provider Demographics
NPI:1548005424
Name:JACOBS-LEWIS, TYLER CHARLES (LMHC)
Entity type:Individual
Prefix:
First Name:TYLER
Middle Name:CHARLES
Last Name:JACOBS-LEWIS
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1165 2ND AVE UNIT 8412
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50301-8519
Mailing Address - Country:US
Mailing Address - Phone:515-344-3163
Mailing Address - Fax:
Practice Address - Street 1:1165 2ND AVE UNIT 8412
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50301-8519
Practice Address - Country:US
Practice Address - Phone:515-344-3163
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-01
Last Update Date:2024-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAT23093101YA0400X
IA111725101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)