Active NPI
Jacob Carlisle Hostetter, CLINICAL COUNSELOR
- Mental Health Counselor
- Dallas, OR
National Provider Identifier
1386187276
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- Practice address
- 182 SW Academy St
Dallas, OR 97338-1996 - Phone
- (503) 623-9289
- NPI assigned
- Nov 23, 2016
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | |||
| Mental Health Counselor | 101YM0800X | Primary |
Addresses
Primary practice location
182 SW Academy St
Dallas, OR 97338-1996
Mailing address
36 SW Nye St
Newport, OR 97365-3821
Phone (541) 265-4179
Other practice location 1
4422 NE Devils Lake Blvd Ste 2
Lincoln City, OR 97367-5000
Phone (541) 265-4196
Other practice location 2
51 SW Lee St
Newport, OR 97365-3823
Phone (541) 574-5960
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Dec 17, 2025 through Dec 17, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1479859200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1569369600000",
"number": "1386187276",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "36 SW NYE ST",
"city": "NEWPORT",
"state": "OR",
"postal_code": "973653821",
"telephone_number": "541-265-4179",
"fax_number": "541-265-4112"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "182 SW ACADEMY ST",
"city": "DALLAS",
"state": "OR",
"postal_code": "973381996",
"telephone_number": "503-623-9289"
}
],
"practiceLocations": [
{
"address_1": "4422 NE Devils Lake Blvd Ste 2",
"address_purpose": "LOCATION",
"city": "Lincoln City",
"state": "OR",
"postal_code": "973675000",
"country_code": "US",
"telephone_number": "541-265-4196",
"fax_number": "541-994-1882",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "51 SW Lee St",
"address_purpose": "LOCATION",
"city": "Newport",
"state": "OR",
"postal_code": "973653823",
"country_code": "US",
"telephone_number": "541-574-5960",
"fax_number": "541-265-0601",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "HOSTETTER",
"first_name": "JACOB",
"middle_name": "CARLISLE",
"name_prefix": "Mr.",
"credential": "CLINICAL COUNSELOR",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2016-11-23",
"last_updated": "2019-09-25",
"status": "A"
},
"taxonomies": [
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": null,
"license": null,
"primary": false
},
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Dallas, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 25, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.