Provider Demographics
NPI:1750111662
Name:YARVIS, JACOB JOSEF (LCSW)
Entity type:Individual
Prefix:
First Name:JACOB
Middle Name:JOSEF
Last Name:YARVIS
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2526 DURWOOD ST APT 207
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78704-5408
Mailing Address - Country:US
Mailing Address - Phone:703-901-2726
Mailing Address - Fax:
Practice Address - Street 1:2526 DURWOOD ST APT 207
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78704-5408
Practice Address - Country:US
Practice Address - Phone:703-901-2726
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-05
Last Update Date:2024-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA228420104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker