Individual
JACOB THOMAS HISELEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PRSS, LMSW, U/S
Contact information
Practice address
1640 W KEETOOWAH ST, TAHLEQUAH, OK 74464-3497
(918) 708-9009
Mailing address
1640 W KEETOOWAH ST, TAHLEQUAH, OK 74464-3497
(918) 708-9009
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
20902
OK
175T00000X
Peer Specialist
130888
OK
Other
Enumeration date
06/26/2018
Last updated
12/29/2025
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