Provider Demographics
NPI:1700635448
Name:ATCHISON, JACOB
Entity type:Individual
Prefix:
First Name:JACOB
Middle Name:
Last Name:ATCHISON
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 1:509 HUNTERS LN
Mailing Address - Street 2:
Mailing Address - City:DICKINSON
Mailing Address - State:TX
Mailing Address - Zip Code:77539-4014
Mailing Address - Country:US
Mailing Address - Phone:817-948-9154
Mailing Address - Fax:
Practice Address - Street 1:509 HUNTERS LN
Practice Address - Street 2:
Practice Address - City:DICKINSON
Practice Address - State:TX
Practice Address - Zip Code:77539-4014
Practice Address - Country:US
Practice Address - Phone:817-948-9154
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-15
Last Update Date:2024-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health