Provider Demographics
NPI:1184669129
Name:TAYLOR, JACOB JUSTIN (MA, CP)
Entity Type:Individual
Prefix:MR
First Name:JACOB
Middle Name:JUSTIN
Last Name:TAYLOR
Suffix:
Gender:M
Credentials:MA, CP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11700 MUKILTEO SPEEDWAY STE 201-1237
Mailing Address - Street 2:
Mailing Address - City:MUKILTEO
Mailing Address - State:WA
Mailing Address - Zip Code:98275-5432
Mailing Address - Country:US
Mailing Address - Phone:425-210-1093
Mailing Address - Fax:
Practice Address - Street 1:4610 200TH ST SW STE J
Practice Address - Street 2:
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98036-6606
Practice Address - Country:US
Practice Address - Phone:425-210-1093
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-16
Last Update Date:2023-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH60149973101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health