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1225863897
JACOB DAVID STARK
PORTLAND, OR
NPI
1225863897
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
101YM0800X Counselor, Mental Health
Enumeration Date
2024-09-04
Last Update Date
2024-09-04
Business Address
JACOB DAVID STARK
10373 NE HANCOCK ST STE 200
PORTLAND, OR 97220-3873
Phone number: 503-253-6754
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Mailing Address
JACOB DAVID STARK
PO BOX 8459
PORTLAND, OR 97207-8459
Phone number: 503-238-0769
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