Individual
MS. TIRZAH D JACOB
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
6129 NE SKIDMORE ST, PORTLAND, OR 97218-2227
(503) 407-9232
Mailing address
6129 NE SKIDMORE ST, PORTLAND, OR 97218-2227
(503) 407-9232
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
C1780
OR
101YP2500X
Professional Counselor
Primary
C1780
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
030027
OAID
OR
01
—
11607801
CAQH
OR
01
—
1265740096
BFHLPC
OR
05
—
500601179
—
OR
01
—
C1780
STATE LICENSE
OR
Enumeration date
07/13/2006
Last updated
06/01/2023
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