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MR. JACOB THOMAS COSTA MS, AMFT

>> Marriage & Family Therapist >> Behavioral Health & Social Service Providers

Registrant NPI Number: 1467024075

Individual Registrant:
MR. JACOB THOMAS COSTA MS, AMFT
Gender: M
Sole Proprietor

Location and contact information for practice:
655 DEEP VALLEY DR STE 265  ROLLING HILLS ESTATES, CA 90274-3620 US
Tel: 310-936-1324  Fax: --

Contact information for business:
1009 ENGLANDER ST  SAN PEDRO, CA 90731-1124 US
Tel: 310-918-9581  Fax: --

Registration Information:
NPI: 1467024075
Entity Type: Individual

Specialty information:

PrimaryCodeCategory/DescriptionStateLicense Number
Y106H00000XBehavioral Health & Social Service Providers
Marriage & Family Therapist
CA126022

Legacy codes, insurance codes and state license numbers:

IssuerNumberStateType




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