Provider Demographics
NPI:1770834285
Name:CURTIS, JACOB HAMILTON
Entity type:Individual
Prefix:
First Name:JACOB
Middle Name:HAMILTON
Last Name:CURTIS
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 1:10151 SW BARBUR BLVD STE 205DC
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97219-5931
Mailing Address - Country:US
Mailing Address - Phone:503-347-4997
Mailing Address - Fax:
Practice Address - Street 1:10151 SW BARBUR BLVD STE 205DC
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97219-5931
Practice Address - Country:US
Practice Address - Phone:503-347-4997
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-24
Last Update Date:2015-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR13-06-13101YA0400X
ORC3912101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)