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NPI Code Detail

MEDICARE: MRS. NANCY S JACOB MSW

MEDICARE: MRS. NANCY S JACOB MSW
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
1101YM0800XMental Health Counselor

General Provider Information

NPI Number : 1740570332
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. NANCY S JACOB MSW
Provider Business Mailing Address
First Line : 8905 NW 115TH ST
Second Line :
City : OKLAHOMA CITY
State : OK
Zip : 73162-2207
Country : US
Telephone Number : 405-722-2352
Fax Number :
Provider Business Practice Location Address
First Line : 8905 NW 115TH ST
Second Line :
City : OKLAHOMA CITY
State : OK
Zip : 73162-2207
Country : US
Telephone Number : 405-722-2352
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/15/2011
Last Update Date : 06/02/2011

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