Healthcare Provider Details

I. General information

NPI: 1871259655
Provider Name (Legal Business Name): JACOB SEAMONS MS, BCBA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/16/2021
Last Update Date: 12/04/2024
Certification Date: 12/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5500 MARKET ST STE 118
BOARDMAN OH
44512-2616
US

IV. Provider business mailing address

270 WASHINGTON BLVD APT 1
YOUNGSTOWN OH
44512-6364
US

V. Phone/Fax

Practice location:
  • Phone: 330-991-9117
  • Fax:
Mailing address:
  • Phone: 234-407-7143
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: