# JESSE WAYNE COBURN

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** Yes

## Provider details

- **NPI number:** 1902463086
- **Gender:** Man
- **Credential:** LSCW, CADC II, SUDP

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 101YA0400X | Addiction (Substance Use Disorder) Counselor | 19-10-32 | OR | — |
| 101YA0400X | Addiction (Substance Use Disorder) Counselor | CP61374175 | WA | — |
| 1041C0700X | Clinical Social Worker | L10830 | OR | — |
| 1041C0700X | Clinical Social Worker | L18030 | OR | — |
| 1041C0700X | Clinical Social Worker | LW61327515 | WA | Yes |

## Other

- **Enumeration date:** 05/23/2019
- **Last updated:** 06/24/2026