Provider Demographics
NPI:1639672876
Name:THOMAS, JACOB JOSEPH (MA, BCBA)
Entity type:Individual
Prefix:MR
First Name:JACOB
Middle Name:JOSEPH
Last Name:THOMAS
Suffix:
Gender:
Credentials:MA, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3745 LONG BEACH BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90807-3340
Mailing Address - Country:US
Mailing Address - Phone:866-523-4268
Mailing Address - Fax:510-900-4310
Practice Address - Street 1:81 VERNON ST APT 210
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94610-4246
Practice Address - Country:US
Practice Address - Phone:925-324-9599
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-14
Last Update Date:2025-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-24-73714103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst