MEDICARE: MATTHEW JACOBSON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1285832352
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MATTHEW JACOBSON

Provider Business Mailing Address
First Line	:	3127 BAY RD
Second Line	:
City	:	FERNDALE
State	:	WA
Zip	:	98248-9691
Country	:	US
Telephone Number	:	360-230-8600
Fax Number	:

Provider Business Practice Location Address
First Line	:	119 N COMMERCIAL ST STE 950A
Second Line	:
City	:	BELLINGHAM
State	:	WA
Zip	:	98225-4590
Country	:	US
Telephone Number	:	360-230-8600
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/10/2007
Last Update Date	:	09/11/2025

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