Patrice Alana Jacob, PH.D.

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

MC60704526 Issued in WA

Practice address

1361 S 15TH Way
Ridgefield, WA 98642-7826

Phone

(360) 643-9217

Fax

(503) 678-9751

NPI assigned

Jan 23, 2017

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in WA

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

Specialty

Mental Health Counselor

Education

Other, 2015

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

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

{
    "created_epoch": "1485129600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1591228800000",
    "number": "1669919148",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1361 S 15TH WAY",
            "city": "RIDGEFIELD",
            "state": "WA",
            "postal_code": "986427826",
            "telephone_number": "360-643-9217",
            "fax_number": "503-678-9751"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1361 S 15TH WAY",
            "city": "RIDGEFIELD",
            "state": "WA",
            "postal_code": "986427826",
            "telephone_number": "360-643-9217",
            "fax_number": "503-678-9751"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1104 Main St Ste 550G",
            "address_purpose": "LOCATION",
            "city": "Vancouver",
            "state": "WA",
            "postal_code": "986602955",
            "country_code": "US",
            "telephone_number": "855-583-2842",
            "fax_number": "503-678-9751",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JACOB",
        "first_name": "PATRICE",
        "middle_name": "ALANA",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2017-01-23",
        "last_updated": "2020-06-04",
        "certification_date": "2020-06-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "WA",
            "license": "MC60704526",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2082041",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Karissa Homola
• Heidi Ann Howe, MSW, SWICL
• Sarah Anne Huddleston, RDH
• Lori Lynn Hughes, RDN, CDN
• Karen M Hynning, PTA
• Jennifer Laura Johnson, PTA
• Tanna K Johnson, LMT
• Judith Kay Johnston, DH
• Joint Ventures Therapeutics, PC
• Sarah Lanae Jones, RN

• All providers in Ridgefield, WA
• Mental Health Counselor in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 4, 2020; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.