Provider Demographics
NPI:1215328026
Name:PAULETTE JOBE LCSW
Entity type:Organization
Organization Name:PAULETTE JOBE LCSW
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:DAETON
Authorized Official - Middle Name:PAULETTE
Authorized Official - Last Name:JOBE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:405-772-7440
Mailing Address - Street 1:5480 MAIN STREET
Mailing Address - Street 2:SUITE 104
Mailing Address - City:DEL CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73115-9998
Mailing Address - Country:US
Mailing Address - Phone:405-772-7440
Mailing Address - Fax:405-601-7796
Practice Address - Street 1:5480 MAIN STREET
Practice Address - Street 2:SUITE 104
Practice Address - City:DEL CITY
Practice Address - State:OK
Practice Address - Zip Code:73115-9998
Practice Address - Country:US
Practice Address - Phone:405-772-7440
Practice Address - Fax:405-601-7796
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-16
Last Update Date:2015-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK39441041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200360040BMedicaid