Provider Demographics
NPI:1770112799
Name:JACOBS, KRISTINE ELIZABETH (MS, LPC)
Entity type:Individual
Prefix:
First Name:KRISTINE
Middle Name:ELIZABETH
Last Name:JACOBS
Suffix:
Gender:F
Credentials:MS, LPC
Other - Prefix:
Other - First Name:KRISTINE
Other - Middle Name:ELIZABETH
Other - Last Name:LIGHTNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:150 KATHRYN DR
Mailing Address - Street 2:
Mailing Address - City:NEW BLOOMFIELD
Mailing Address - State:PA
Mailing Address - Zip Code:17068-8645
Mailing Address - Country:US
Mailing Address - Phone:717-609-2890
Mailing Address - Fax:
Practice Address - Street 1:25 E MCCLURE ST
Practice Address - Street 2:
Practice Address - City:NEW BLOOMFIELD
Practice Address - State:PA
Practice Address - Zip Code:17068-9334
Practice Address - Country:US
Practice Address - Phone:717-798-0383
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-02
Last Update Date:2020-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC009183101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional