Individual
MR. BRIAN PHILLIP JACOBY I
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MA
Contact information
Practice address
847 NE 19TH AVE STE 100, PORTLAND, OR 97232-2684
(979) 275-7895
Mailing address
PO BOX 8459, PORTLAND, OR 97207-8459
(979) 275-7895
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
101YP2500X
Professional Counselor
Primary
C3747
OR
Other
Enumeration date
08/30/2010
Last updated
02/19/2016
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