Individual
JUSTIN JACOBS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
10151 SE SUNNYSIDE RD STE 480, CLACKAMAS, OR 97015-5705
(971) 915-0046
Mailing address
10151 SE SUNNYSIDE RD STE 480, CLACKAMAS, OR 97015-5705
(971) 915-0046
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
103T00000X
Psychologist
Primary
R272
OR
103TC0700X
Clinical Psychologist
R272
OR
171M00000X
Case Manager/Care Coordinator
—
—
Other
Enumeration date
07/26/2022
Last updated
11/29/2024
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