Healthcare Provider Details

I. General information

NPI: 1902578628
Provider Name (Legal Business Name): JAVEEN LYNETTE SKOUBO PSYD.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/30/2021
Last Update Date: 04/04/2025
Certification Date: 04/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

814 NE 87TH AVE
VANCOUVER WA
98664-1915
US

IV. Provider business mailing address

211 SE CARUTHERS ST
PORTLAND OR
97214-4502
US

V. Phone/Fax

Practice location:
  • Phone: 360-910-1522
  • Fax:
Mailing address:
  • Phone: 503-224-1044
  • Fax: 971-260-0355

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPY61631633
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberR252
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: