Individual
JACOB BREWER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
405 E EXCELSIOR AVE, VINITA, OK 74301-4226
(918) 256-6476
Mailing address
1617 D ST NE, MIAMI, OK 74354-2743
(918) 325-3641
Taxonomy
Speciality
Code
Description
License number
State
103TC1900X
Counseling Psychologist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0HG71
—
OK
Enumeration date
02/24/2021
Last updated
02/24/2021
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