Provider Demographics
NPI:1043736762
Name:TRUMAN, JACOB
Entity Type:Individual
Prefix:
First Name:JACOB
Middle Name:
Last Name:TRUMAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:249 E TABERNACLE ST STE 100
Mailing Address - Street 2:
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84770-2951
Mailing Address - Country:US
Mailing Address - Phone:435-705-7574
Mailing Address - Fax:801-255-5131
Practice Address - Street 1:249 E TABERNACLE ST STE 100
Practice Address - Street 2:
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84770-2951
Practice Address - Country:US
Practice Address - Phone:435-705-7574
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-15
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172V00000XOther Service ProvidersCommunity Health Worker
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty