Individual provider Active NPI

Jacob Hunt

  • Clinical Social Worker
  • Portland, OR
National Provider Identifier
1538618723
Registry record updated Mar 21, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
L10908 Issued in OR
Practice address
12636 SE Stark St BLDG J
Portland, OR 97233-1058
Phone
(503) 253-4600
NPI assigned
Sep 28, 2016
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 21, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X L10908 OR Primary

Addresses

Primary practice location

12636 SE Stark St BLDG J
Portland, OR 97233-1058

Mailing address

12636 SE Stark St BLDG J
Portland, OR 97233-1058
Phone (503) 253-4600

Other practice location 1

8915 SW Center St
Tigard, OR 97223-6307
Phone (503) 726-3740

Other practice location 2

1312 SW Washington St
Portland, OR 97205-2327
Phone (503) 535-1150

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
I20220824003131 OR Practitioner - Clinical Social Worker 2264816263 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

1700 NW Civic Dr
Suite 310
Gresham, OR 97030-3774
Phone (503) 666-8832

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
L10908ORMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Western Psychological and Counseling Services LLC Mental Health CurrentSince May 24, 2023 Accepting new patients
Western Psychological and Counseling Services LLC Mental Health CurrentSince May 24, 2023 Accepting new patients

Locations

880 82nd Dr
Gladstone, OR 97027
Phone (503) 626-9494

1700 NW Civic Dr
Ste 310
Gresham, OR 97030
Phone (503) 666-8832

12636 SE Stark St
Bldg J
Portland, OR 97233
Phone (503) 253-4600

18765 SW Boones Ferry Rd
Ste 100
Tualatin, OR 97062
Phone (503) 612-1000

Interoperability endpoints

  • Direct secure messaging: lifestancehealth.jacobhunt@148835.advancedmd-direct.com

Organizations & group practices 2

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

NPI Registry JSON

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

{
    "created_epoch": "1475020800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1742515200000",
    "number": "1538618723",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12636 SE STARK ST BLDG J",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972331058",
            "telephone_number": "503-253-4600"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12636 SE STARK ST BLDG J",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972331058",
            "telephone_number": "503-253-4600"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "8915 SW Center St",
            "address_purpose": "LOCATION",
            "city": "Tigard",
            "state": "OR",
            "postal_code": "972236307",
            "country_code": "US",
            "telephone_number": "503-726-3740",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1312 SW Washington St",
            "address_purpose": "LOCATION",
            "city": "Portland",
            "state": "OR",
            "postal_code": "972052327",
            "country_code": "US",
            "telephone_number": "503-535-1150",
            "fax_number": "503-535-1192",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HUNT",
        "first_name": "JACOB",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2016-09-28",
        "last_updated": "2025-03-21",
        "certification_date": "2025-03-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "OR",
            "license": "L10908",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Portland, OR

Sources for this page

Verify at the official NPI Registry.