Provider Demographics
NPI:1437681368
Name:GOBEILLE, JACOB
Entity Type:Individual
Prefix:
First Name:JACOB
Middle Name:
Last Name:GOBEILLE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1230 NEVADA ST
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98229-5719
Mailing Address - Country:US
Mailing Address - Phone:253-315-0064
Mailing Address - Fax:
Practice Address - Street 1:609 NORTHSHORE DR
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98226-4414
Practice Address - Country:US
Practice Address - Phone:360-676-6000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-30
Last Update Date:2017-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health