NPIMap

Organization Active NPI

Diana Jacobs PHD. Licensed Psychologist PS

  • Clinical Psychologist
  • Bellingham, WA
National Provider Identifier
1245761188
Registry record updated Jun 3, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
PY00002516 Issued in WA
Legal business name
DIANA JACOBS PHD. LICENSED PSYCHOLOGIST PS
Practice address
960 Harris Ave Ste 205
Bellingham, WA 98225-7025
Phone
(360) 734-7310
Fax
(360) 647-8336
NPI assigned
Mar 22, 2017
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 3, 2019

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Diana Jacobs, PHDNPI 1790883353
Title
Owner
Phone
(360) 734-7310

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical PsychologistGroup: 193400000X SINGLE SPECIALTY GROUP 103TC0700X PY00002516 WA Primary

Addresses

Primary practice location

960 Harris Ave Ste 205
Bellingham, WA 98225-7025

Mailing address

12 Bellwether Way Ste 220
Bellingham, WA 98225-2914
Phone (360) 734-7310

Other identifiers 1

IdentifierTypeStateIssuer
1790883353OtherWANPI

National Provider Directory

National Provider Directory

Locations

960 Harris Ave
Ste 205
Bellingham, WA 98225

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1490140800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1559520000000",
    "number": "1245761188",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12 BELLWETHER WAY STE 220",
            "city": "BELLINGHAM",
            "state": "WA",
            "postal_code": "982252914",
            "telephone_number": "360-734-7310",
            "fax_number": "360-647-8336"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "960 HARRIS AVE STE 205",
            "city": "BELLINGHAM",
            "state": "WA",
            "postal_code": "982257025",
            "telephone_number": "360-734-7310",
            "fax_number": "360-647-8336"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DIANA JACOBS PHD. LICENSED PSYCHOLOGIST PS",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-03-22",
        "last_updated": "2019-06-03",
        "status": "A",
        "authorized_official_last_name": "JACOBS",
        "authorized_official_first_name": "DIANA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "360-734-7310",
        "authorized_official_credential": "PHD"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist, Clinical",
            "state": "WA",
            "license": "PY00002516",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1790883353",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Bellingham, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 3, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.