Individual provider Active NPI

Jacob Dickinson, M.A.

  • Marriage & Family Therapist
  • Beaverton, OR
National Provider Identifier
1508015975
Registry record updated May 27, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Marriage & Family TherapistTaxonomy code 106H00000X
License
T0845 Issued in OR
Practice address
9670 SW Beaverton Hillsdale Hwy
Beaverton, OR 97005-3307
Phone
(971) 229-4009
Fax
(866) 324-6009
NPI assigned
Sep 10, 2008
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 27, 2026

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X C2887 OR
Marriage & Family Therapist 106H00000X T0845 OR Primary

Addresses

Primary practice location

9670 SW Beaverton Hillsdale Hwy
Beaverton, OR 97005-3307

Mailing address

10824 SE Oak St Ste 314
Milwaukie, OR 97222-6694
Phone (971) 229-4009

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250801003507 OR Practitioner - Marriage and Family Therapist 8426492786 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Master of Arts

State licenses

LicenseStateTypeSpecialty
C2887ORMDMental Health Counselor
T0845ORMDMarriage & Family Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Brightspire Health, LLC CurrentSince Apr 10, 2023 Accepting new patients

Locations

9670 SW Beaverton Hillsdale Hwy
Beaverton, OR 97005
Phone (503) 626-9494

825 NE 20th Ave
Ste 120
Portland, OR 97232
Phone (971) 229-4009

10824 SE Oak St
Portland, OR 97222
Phone (717) 516-1080

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1221004800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1779840000000",
    "number": "1508015975",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10824 SE OAK ST STE 314",
            "city": "MILWAUKIE",
            "state": "OR",
            "postal_code": "972226694",
            "telephone_number": "971-229-4009",
            "fax_number": "866-324-6009"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9670 SW BEAVERTON HILLSDALE HWY",
            "city": "BEAVERTON",
            "state": "OR",
            "postal_code": "970053307",
            "telephone_number": "971-229-4009",
            "fax_number": "866-324-6009"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DICKINSON",
        "first_name": "JACOB",
        "name_prefix": "Mr.",
        "credential": "M.A.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-09-10",
        "last_updated": "2026-05-27",
        "certification_date": "2026-05-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "OR",
            "license": "C2887",
            "primary": false
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "OR",
            "license": "T0845",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Beaverton, OR

Sources for this page

Verify at the official NPI Registry.