Bethanie Jacques, LCPC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

CC4878 Issued in ME

Practice address

741 Warren Ave
Portland, ME 04103-1007

Phone

(207) 879-6165

Fax

(207) 879-7466

NPI assigned

May 18, 2012

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in ME

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

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Spurwink Services Incorporated

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Portland, ME
  • NPI 1760507297
  Medicare reassignment NPD
• Spurwink Services Incorporated

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Portland, ME
  • NPI 1316945090
  NPD (past)

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

{
    "created_epoch": "1337299200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658620800000",
    "number": "1669732152",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 150",
            "city": "WESTBROOK",
            "state": "ME",
            "postal_code": "040980150",
            "telephone_number": "207-879-6165",
            "fax_number": "207-879-7466"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "741 WARREN AVE",
            "city": "PORTLAND",
            "state": "ME",
            "postal_code": "041031007",
            "telephone_number": "207-879-6165",
            "fax_number": "207-879-7466"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACQUES",
        "first_name": "BETHANIE",
        "credential": "LCPC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2012-05-18",
        "last_updated": "2022-07-24",
        "certification_date": "2022-07-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "ME",
            "license": "XL3960",
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "ME",
            "license": "CC4878",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Elizabeth Broadaway Jacobson, MS OTR/L
• Linda Harmon Jacobson, APRN CNS
• Tawnia Lynn Jacobson, APRN, CRNA
• Lawrence Jacoby, DMD, MPH
• Mariela Jacome
• Jessica Jacques, LCPC-CC
• Marc P Jacquet, MD
• Tara A Jacquet, MS CCC SLP
• Jade Trade Inc.
• Caroline Jaeger, DO

• Professional Counselor in Portland, ME
• Providers in Portland, ME by specialty
• Professional Counselor in Maine

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 24, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.