Provider Demographics
NPI:1790420495
Name:NEWLAND, JACOB
Entity Type:Individual
Prefix:
First Name:JACOB
Middle Name:
Last Name:NEWLAND
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 1:170 DEEP WOOD DR STE 104
Mailing Address - Street 2:
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78681-4949
Mailing Address - Country:US
Mailing Address - Phone:512-910-3251
Mailing Address - Fax:
Practice Address - Street 1:170 DEEP WOOD DR STE 104
Practice Address - Street 2:
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78681-4949
Practice Address - Country:US
Practice Address - Phone:512-910-3251
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-28
Last Update Date:2022-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician