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NPI Code Detail

MEDICARE: JUSTIN BABCOCK

MEDICARE: JUSTIN BABCOCK
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
1101YM0800XMental Health Counselor

General Provider Information

NPI Number : 1659055986
Entity Type Code : Individual
Provider Name (Legal Business Name) : JUSTIN BABCOCK
Provider Business Mailing Address
First Line : 130 MAIN ST W APT 404
Second Line :
City : MONMOUTH
State : OR
Zip : 97361-2119
Country : US
Telephone Number : 541-279-8767
Fax Number :
Provider Business Practice Location Address
First Line : 182 SW ACADEMY ST
Second Line :
City : DALLAS
State : OR
Zip : 97338-1996
Country : US
Telephone Number : 503-623-9289
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/15/2023
Last Update Date : 02/13/2026

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