Healthcare Provider Details

I. General information

NPI: 1386394237
Provider Name (Legal Business Name): JAMIE MATTHEW KUBESS CSWA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/24/2022
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12655 SW CENTER ST STE 100
BEAVERTON OR
97005-1600
US

IV. Provider business mailing address

9600 SW OAK ST STE 500&520
TIGARD OR
97223-6583
US

V. Phone/Fax

Practice location:
  • Phone: 503-828-3402
  • Fax:
Mailing address:
  • Phone: 971-364-8069
  • Fax: 971-209-7261

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number25-03-11434
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberA15996
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: