Provider Demographics
NPI:1184782765
Name:JACOBS, NOEL JAMESON (PHD)
Entity type:Individual
Prefix:DR
First Name:NOEL
Middle Name:JAMESON
Last Name:JACOBS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4621 NW 157TH TER
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73013-8954
Mailing Address - Country:US
Mailing Address - Phone:405-285-4440
Mailing Address - Fax:405-271-8709
Practice Address - Street 1:1200 N PHILLIPS AVE
Practice Address - Street 2:SUITE 12400
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73104-4600
Practice Address - Country:US
Practice Address - Phone:405-285-4440
Practice Address - Fax:405-271-8709
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2011-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK980103TH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200099360AMedicaid