Provider Demographics
NPI:1831400118
Name:JOBE, DAETON PAULETTE (LCSW)
Entity type:Individual
Prefix:
First Name:DAETON
Middle Name:PAULETTE
Last Name:JOBE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5480 MAIN ST.
Mailing Address - Street 2:SUITE 104
Mailing Address - City:DEL CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73115-6004
Mailing Address - Country:US
Mailing Address - Phone:405-722-7440
Mailing Address - Fax:405-601-7796
Practice Address - Street 1:316 S MIDWEST BLVD
Practice Address - Street 2:
Practice Address - City:MIDWEST CITY
Practice Address - State:OK
Practice Address - Zip Code:73110-4642
Practice Address - Country:US
Practice Address - Phone:405-733-5437
Practice Address - Fax:405-732-7741
Is Sole Proprietor?:No
Enumeration Date:2010-07-01
Last Update Date:2015-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK39441041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical