=====================================================
General NPI Number Information
=====================================================
NPI Number | 1073456323
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JASON ESCOBAR
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/13/2026
-----------------------------------------------------
Last Update Date | 04/13/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1701 5TH AVE STE 194
-----------------------------------------------------
City | CHARLESTON
-----------------------------------------------------
State | WV
-----------------------------------------------------
Zip | 25387-1900
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 304-408-3253
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 332 12TH ST APT 301
-----------------------------------------------------
City | HUNTINGTON
-----------------------------------------------------
State | WV
-----------------------------------------------------
Zip | 25701-1569
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 304-544-5971
-----------------------------------------------------
Fax | 304-756-8230
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 175T00000X
-----------------------------------------------------
Taxonomy Name | Peer Specialist
-----------------------------------------------------
License Number | 26-921SUD
-----------------------------------------------------
License Number State | WV
-----------------------------------------------------