Provider Demographics
NPI:1568806180
Name:JENSEN, JACOB MCBRIDE (BS)
Entity Type:Individual
Prefix:
First Name:JACOB
Middle Name:MCBRIDE
Last Name:JENSEN
Suffix:
Gender:M
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1122 NW 34TH ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73118-5613
Mailing Address - Country:US
Mailing Address - Phone:405-924-6151
Mailing Address - Fax:
Practice Address - Street 1:400 S BROADWAY S SUITE 6
Practice Address - Street 2:
Practice Address - City:EDMIND
Practice Address - State:OK
Practice Address - Zip Code:73034
Practice Address - Country:US
Practice Address - Phone:405-318-6593
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-25
Last Update Date:2013-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst