Provider Demographics
NPI:1710257878
Name:JOST-BABIN, DARLENE (MFT, LPC)
Entity Type:Individual
Prefix:
First Name:DARLENE
Middle Name:
Last Name:JOST-BABIN
Suffix:
Gender:F
Credentials:MFT, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:693 RAY J GLATT CIRCLE
Mailing Address - Street 2:
Mailing Address - City:WOODBURN
Mailing Address - State:OR
Mailing Address - Zip Code:97071
Mailing Address - Country:US
Mailing Address - Phone:503-982-0403
Mailing Address - Fax:
Practice Address - Street 1:693 RAY J GLATT CIRCLE
Practice Address - Street 2:
Practice Address - City:WOODBURN
Practice Address - State:OR
Practice Address - Zip Code:97071
Practice Address - Country:US
Practice Address - Phone:503-982-0403
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-06
Last Update Date:2012-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC2567101YP2500X
ORT0753106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR930281321OtherTAX ID
ORC2567OtherBOARD OF LICENSED PROFESSIONAL COUNSELORS AND THERAPISTS
ORT0753OtherBOARD OF LICENSED PROFESSIONAL COUNSELORS AND THERAPISTS