Basic Information
| Provider Information | |||||||||
| NPI: | 1285886440 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ISACSON | ||||||||
| FirstName: | JASON | ||||||||
| MiddleName: | KEITH | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | M.ED., LPC, LMFT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2750 SUTTERVILLE RD | ||||||||
| Address2: | |||||||||
| City: | SACRAMENTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 958201093 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9162908229 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2750 SUTTERVILLE RD | ||||||||
| Address2: | |||||||||
| City: | SACRAMENTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 958201093 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9164523981 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/21/2008 | ||||||||
| LastUpdateDate: | 01/28/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 01/27/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | 1380 | CA | N | Behavioral Health & Social Service Providers | Counselor | Professional | 101YP2500X | 0701004454 | VA | N | Behavioral Health & Social Service Providers | Counselor | Professional | 106H00000X | 48847 | CA | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.