Provider Demographics
NPI:1689006850
Name:JACOBS, CHAD CHRISTOPHER (MED, LPC)
Entity Type:Individual
Prefix:MR
First Name:CHAD
Middle Name:CHRISTOPHER
Last Name:JACOBS
Suffix:
Gender:M
Credentials:MED, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:710 NW AUTUMNCREEK WAY
Mailing Address - Street 2:#L305
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97006-9008
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9755 SW BARNES RD STE 650
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97225-6657
Practice Address - Country:US
Practice Address - Phone:503-444-4862
Practice Address - Fax:503-648-0755
Is Sole Proprietor?:No
Enumeration Date:2013-07-30
Last Update Date:2023-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA3741101Y00000X
ORC2925101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor