Provider Demographics
NPI:1447994710
Name:JACOBSSON, LEA-REBECCA WHITMER
Entity type:Individual
Prefix:
First Name:LEA-REBECCA
Middle Name:WHITMER
Last Name:JACOBSSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:TAINE 216, POLANCO, 22550
Mailing Address - Street 2:
Mailing Address - City:MEXICO CITY
Mailing Address - State:MEXICO CITY
Mailing Address - Zip Code:11560
Mailing Address - Country:MX
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:TAINE 216, POLANCO, 22550
Practice Address - Street 2:
Practice Address - City:MEXICO CITY
Practice Address - State:MEXICO CITY
Practice Address - Zip Code:11560
Practice Address - Country:MX
Practice Address - Phone:553-687-7141
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-23
Last Update Date:2022-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor