Healthcare Provider Details

I. General information

NPI: 1578157475
Provider Name (Legal Business Name): JACOB OOSTENDORP LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/22/2021
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 NW BETHANY BLVD STE 320
BEAVERTON OR
97006-5238
US

IV. Provider business mailing address

1500 NW BETHANY BLVD STE 320
BEAVERTON OR
97006-5238
US

V. Phone/Fax

Practice location:
  • Phone: 503-567-3260
  • Fax: 503-567-3264
Mailing address:
  • Phone: 503-567-3260
  • Fax: 503-567-3264

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC-9008
License Number StateID
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPC-9008
License Number StateID
# 3
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberC10353
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: