Provider Demographics
NPI:1962282731
Name:MCEWEN, JACOB (MA, LMFTA)
Entity type:Individual
Prefix:
First Name:JACOB
Middle Name:
Last Name:MCEWEN
Suffix:
Gender:M
Credentials:MA, LMFTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1204 E AUGUSTA AVE
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99207-2438
Mailing Address - Country:US
Mailing Address - Phone:208-741-0107
Mailing Address - Fax:
Practice Address - Street 1:1402 S GRAND BLVD STE 201
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99203-5001
Practice Address - Country:US
Practice Address - Phone:509-209-9664
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-29
Last Update Date:2023-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMG61449528106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist