Jake Antonini

NPI #1063840700 in Tigard, Oregon

Provider Information

NPI Number: 1063840700
Entity Type: Individual
Name: Jake Antonini
Gender: Not Specified
Sole Proprietor: Yes
Primary Specialty: Counselor - Mental Health
Enumeration Date: Oct 16, 2013
Last Updated: Oct 16, 2013

Practice Location

Address: 8915 SW CENTER ST
City: Tigard
State: Oregon
ZIP Code: 97223-6307
Phone: (503) 726-3698

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Counselor - Mental Health — Mental Health	101YM0800X	Primary

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