Healthcare Provider Details

I. General information

NPI: 1487973178
Provider Name (Legal Business Name): MR. JACOB ALHRIC GERMANY
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/20/2010
Last Update Date: 12/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6803 S WESTERN AVE STE 300
OKLAHOMA CITY OK
73139-1814
US

IV. Provider business mailing address

6803 S WESTERN AVE STE 300
OKLAHOMA CITY OK
73139-1814
US

V. Phone/Fax

Practice location:
  • Phone: 405-315-1551
  • Fax:
Mailing address:
  • Phone: 405-315-1551
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: