Provider Demographics
NPI:1417631839
Name:BELLEPU, JACOB O.
Entity Type:Individual
Prefix:
First Name:JACOB O.
Middle Name:
Last Name:BELLEPU
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 1:2417 INDEPENDENCE BLVD
Mailing Address - Street 2:
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79601-4776
Mailing Address - Country:US
Mailing Address - Phone:443-858-0730
Mailing Address - Fax:
Practice Address - Street 1:2417 INDEPENDENCE BLVD
Practice Address - Street 2:
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79601-4776
Practice Address - Country:US
Practice Address - Phone:443-858-0730
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-14
Last Update Date:2023-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician