Provider Demographics
NPI:1699659409
Name:JACOBO, MIKEL ALEXANDER (QMHA)
Entity type:Individual
Prefix:
First Name:MIKEL
Middle Name:ALEXANDER
Last Name:JACOBO
Suffix:
Gender:M
Credentials:QMHA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1160 W 15TH AVE APT 207
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97402-3910
Mailing Address - Country:US
Mailing Address - Phone:909-319-2978
Mailing Address - Fax:
Practice Address - Street 1:770 E 11TH AVE FL 2
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-3746
Practice Address - Country:US
Practice Address - Phone:458-205-7085
Practice Address - Fax:458-205-7089
Is Sole Proprietor?:No
Enumeration Date:2025-08-04
Last Update Date:2025-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR25-QMHA-I-004910101YM0800X, 171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No171M00000XOther Service ProvidersCase Manager/Care Coordinator