MARK JACOB (NPI# 1245285295) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1245285295 |
| Entity Type | Individual |
| Full Name | MARK JACOB |
| Credential | LCSW |
| Practice Address |
801 Church Street Suite 1 Decatur AL 35602 |
| Mailing Address |
2868 Acton Road Birmingham AL 35243 |
| Practice Telephone | 2563554461 |
| Practice Fax Number | 2563554370 |
| Mailing Telephone | 2059688360 |
| Mailing Fax Number | 2059688373 |
| Enumeration Date | 2006-05-24 |
| Last Update Date | 2007-07-08 |
| Gender Code | M |
| Is Sole Proprietor | X |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 103TC1900X |
Psychologist Specialization: Counseling |
1081C | AL | Behavioral Health & Social Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| AL | BCBS | 51522567 | 01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1275659955 | Mark William Jacob | Dentist | 4119 Dundee Rd, Northbrook, IL 60062-2129 | 2007-03-22 |
| 1306126032 | Mark Jacob | Nurse Practitioner | 13737 Noel Rd, Suite 1200, Dallas, TX 75240-1331 | 2011-08-25 |
| 1063688497 | Mark Kevin Jacob | Internal Medicine | 300 E Warwick Dr, Alma, MI 48801-1014 | 2008-05-06 |
| 1952524399 | Mark Alan Jacob | Internal Medicine | 4330 Medical Dr Ste 500, San Antonio, TX 78229-3318 | 2007-04-11 |
| 1659486751 | Mark B Jacob | Oral & Maxillofacial Surgery | 1740 W Taylor St, Chicago, IL 60612-7232 | 2006-08-20 |
| Street Address |
801 CHURCH STREET SUITE 1 |
| City | DECATUR |
| State | AL |
| Zip Code | 35602 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1033361639 | Shelia Harris Kasulka | Registered Nurse | 801 Church Street, Suite 1, Decatur, AL 35602 | 2008-10-15 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1861044703 | Latasha Heinzen | Counselor | 2042 Beltline Rd Suite 120a, Decatur, AL 35602 | 2019-07-11 |
| 1134451685 | Shana D Crumbough | Case Manager/Care Coordinator | 4110 Highway 31 S, Decatur, AL 35602 | 2010-02-09 |
| 1881887479 | Addiction & Mental Health Services Inc | Clinic/Center | 2531 Highway 20 West, Decatur, AL 35602 | 2007-08-27 |
| 1851377527 | Venkata Babu Kantamneni | Internal Medicine | 2828 Highway 31 South, Suite 117, Decatur, AL 35602 | 2005-12-15 |
| 1922241678 | Brian Ruble | Case Manager/Care Coordinator | 4110 Highway 31 South, Decatur, AL 35602 | 2009-04-10 |
| 1447453600 | Leah F Oakley | Registered Nurse | 4110 Highway 31 South, Decatur, AL 35602 | 2007-06-06 |
| 1245313519 | Decatur Digestive Diseases PC | Internal Medicine | 2828 Hwy 31 South, Suite 117, Decatur, AL 35602 | 2006-10-23 |
| 1033298005 | North Central Alabama Mental Retardation Authority, Inc. | Case Management | 445 East Moulton Street Ne, Decatur, AL 35602-0597 | 2006-11-02 |
| 1801103387 | State of Alabama Department of Public Health | Nurse Practitioner | 510 Cherry St. Ne, Decatur, AL 35602-1628 | 2010-09-07 |
| Taxonomy Code | 103TC1900X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Psychologist |
| Specialization | Counseling |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1598098949 | Lynyetta G Willis | Psychologist | 308 Clairemont Ave, Decatur, GA 30030-2506 | 2009-09-16 |
| 1619177409 | Shirley Jean Jordan | Psychologist | 506 N Miller St, Decatur, TX 76234-1114 | 2007-07-20 |
| 1952393308 | Michal Ann O'leary | Psychologist | 1945 Mason Mill Rd, Suite 100, Decatur, GA 30033-4006 | 2005-08-20 |
| 1548269418 | Cynthia Kay Valley | Psychologist | 1549 Clairmont Rd, Suite 108, Decatur, GA 30033-4639 | 2005-07-21 |
| 1841807591 | Mallorie Gayle Carroll | Psychologist | 1670 Clairmont Rd, Decatur, GA 30033-4004 | 2020-09-28 |
| 1164036570 | Rachel Heatherly | Psychologist | 1670 Clairmont Rd, Decatur, GA 30033-4004 | 2020-09-02 |
| 1033462486 | Karuna Counseling, Inc. | Psychologist | 1945 Mason Mill Rd Ste 100, Decatur, GA 30033-4075 | 2012-10-23 |
| 1093087876 | Kathryn Ganske | Psychologist | 1549 Clairmont Rd, Suite 108, Decatur, GA 30033-4639 | 2012-02-08 |
| 1073807608 | Alaycia Deneen Reid | Psychologist | 315 W Ponce De Leon Ave, Decatur Court, Suite 552, Decatur, GA 30030-2400 | 2011-05-31 |
| 1801192661 | Luis Felipe Valdes | Psychologist | 2785 Lawrenceville Hwy, Suite 108, Decatur, GA 30033-2515 | 2011-01-26 |
| Find all providers in DECATUR | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.