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NPI Code Detail

MEDICARE: MR. JASON KEITH ISACSON M.ED., LPC, LMFT

MEDICARE: MR. JASON KEITH ISACSON M.ED., LPC, LMFT
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
1101YP2500XProfessional Counselor1380CA
2101YP2500XProfessional Counselor0701004454VA
3106H00000XMarriage & Family Therapist48847CA

General Provider Information

NPI Number : 1285886440
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. JASON KEITH ISACSON M.ED., LPC, LMFT
Provider Business Mailing Address
First Line : 2750 SUTTERVILLE RD
Second Line :
City : SACRAMENTO
State : CA
Zip : 95820-1093
Country : US
Telephone Number : 916-290-8229
Fax Number :
Provider Business Practice Location Address
First Line : 2750 SUTTERVILLE RD
Second Line :
City : SACRAMENTO
State : CA
Zip : 95820-1093
Country : US
Telephone Number : 916-452-3981
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/21/2008
Last Update Date : 01/28/2021

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