Provider Demographics
NPI:1316188717
Name:JACOBSON, CRAIG BRIAN (AAC, CDPT)
Entity Type:Individual
Prefix:MR
First Name:CRAIG
Middle Name:BRIAN
Last Name:JACOBSON
Suffix:
Gender:M
Credentials:AAC, CDPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 E OLIVE ST
Mailing Address - Street 2:SOUND MENTAL HEALTH
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98122-2735
Mailing Address - Country:US
Mailing Address - Phone:206-302-2200
Mailing Address - Fax:206-302-2210
Practice Address - Street 1:6100 SOUTHCENTER BLVD
Practice Address - Street 2:SOUND MENTAL HEALTH, SUITE 200
Practice Address - City:TUKWILA
Practice Address - State:WA
Practice Address - Zip Code:98188-2441
Practice Address - Country:US
Practice Address - Phone:206-444-7946
Practice Address - Fax:206-444-7810
Is Sole Proprietor?:No
Enumeration Date:2009-03-13
Last Update Date:2017-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACG60111492101YM0800X
WACP60418176101YA0400X
WACO60158294390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program