Healthcare Provider Details

I. General information

NPI: 1669225454
Provider Name (Legal Business Name): ALEXYS B JACOBS CBT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2024
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7521 E NORA AVE
SPOKANE VALLEY WA
99212-2516
US

IV. Provider business mailing address

7521 E NORA AVE
SPOKANE VALLEY WA
99212-2516
US

V. Phone/Fax

Practice location:
  • Phone: 509-475-1808
  • Fax: 509-463-3632
Mailing address:
  • Phone: 509-475-1807
  • Fax: 509-463-3632

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: