Provider Demographics
NPI:1780018283
Name:JACOBS, TERRI
Entity Type:Individual
Prefix:
First Name:TERRI
Middle Name:
Last Name:JACOBS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1515 DAKOTA ST
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73069-6807
Mailing Address - Country:US
Mailing Address - Phone:405-694-0014
Mailing Address - Fax:
Practice Address - Street 1:10948 N MAY AVE
Practice Address - Street 2:SUITE B
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73120-6223
Practice Address - Country:US
Practice Address - Phone:405-751-8889
Practice Address - Fax:405-751-8889
Is Sole Proprietor?:No
Enumeration Date:2013-09-03
Last Update Date:2013-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health