MEDICARE: DR. STUART IRV JACOBSON LICENSED CLINICAL SO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	LCSW0008	OK
2	106H00000X	Marriage & Family Therapist	LMFT334	OK

General Provider Information

NPI Number	:	1407060254
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STUART IRV JACOBSON LICENSED CLINICAL SO

Provider Business Mailing Address
First Line	:	4528 SOUTH SHERIDAN AVE
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74145
Country	:	US
Telephone Number	:	918-745-2463
Fax Number	:

Provider Business Practice Location Address
First Line	:	4528 SOUTH SHERIDAN AVE
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74145
Country	:	US
Telephone Number	:	918-745-2463
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/10/2007
Last Update Date	:	09/11/2025

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