Active NPI
Brian Phillip Jacoby I, MA
- Professional Counselor
- Portland, OR
National Provider Identifier
1144536020
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- C3747
- Practice address
- 847 NE 19TH Ave Ste 100
Portland, OR 97232-2684 - Phone
- (979) 275-7895
- NPI assigned
- Aug 30, 2010
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | C3747 | OR | Primary |
| Mental Health Counselor | 101YM0800X |
Addresses
Primary practice location
847 NE 19TH Ave Ste 100
Portland, OR 97232-2684
Mailing address
PO Box 8459
Portland, OR 97207-8459
Phone (979) 275-7895
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Arts
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| C3747 | OR | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1283126400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1455840000000",
"number": "1144536020",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 8459",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972078459",
"telephone_number": "979-275-7895"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "847 NE 19TH AVE STE 100",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972322684",
"telephone_number": "979-275-7895"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACOBY",
"first_name": "BRIAN",
"middle_name": "PHILLIP",
"name_prefix": "Mr.",
"name_suffix": "I",
"credential": "MA",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2010-08-30",
"last_updated": "2016-02-19",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "OR",
"license": "C3747",
"primary": true
},
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": null,
"license": null,
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Portland, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 19, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.