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Individual
MR. JAKE ALEX MEHL
Active
Individual
MR. JAKE ALEX MEHL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
SUDP
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
261QR0405X
—
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1124159157
EVERGREEN RECOVERY CENTER
WA
Enumeration date
12/26/2018
Last updated
08/30/2023
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