MEDICARE: JACOB JONES LCSW

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	63521	TX

General Provider Information

NPI Number	:	1780447268
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACOB JONES LCSW

Provider Business Mailing Address
First Line	:	4013 MEADOWBROOK DR
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76103-2603
Country	:	US
Telephone Number	:	817-896-8205
Fax Number	:

Provider Business Practice Location Address
First Line	:	4013 MEADOWBROOK DR
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76103-2603
Country	:	US
Telephone Number	:	817-896-8205
Fax Number	:

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

Provider Enumeration Date	:	02/06/2024
Last Update Date	:	02/06/2024

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