Provider Demographics
NPI:1386981280
Name:OREAR, JAKE MICHAEL
Entity type:Individual
Prefix:
First Name:JAKE
Middle Name:MICHAEL
Last Name:OREAR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5204 JOHNSON POINT RD NE
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98516-9531
Mailing Address - Country:US
Mailing Address - Phone:360-701-8227
Mailing Address - Fax:
Practice Address - Street 1:5204 JOHNSON POINT RD NE
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98516-9531
Practice Address - Country:US
Practice Address - Phone:360-701-8227
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-11
Last Update Date:2018-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-18-33738103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
1-18-33738OtherBEHAVIOR ANALYST CERTIFICATION BOARD