NPI Details
Jesse Wayne Coburn, LSCW, CADC II, SUDP is a clinical social worker in Hill Afb, UT. The provider is a social worker who holds a master's or doctoral degree in social work from an accredited school of social work in addition to at least two years of post-master's supervised experience in a clinical setting. The social worker must be licensed, certified, or registered at the clinical level in the jurisdiction of practice. A clinical social worker provides direct services, including interventions focused on interpersonal interactions, intrapsychic dynamics, and life management issues. Clinical social work services are based on bio-psychosocial perspectives. Services consist of assessment, diagnosis, treatment (including psychotherapy and counseling), client-centered advocacy, consultation, evaluation, and prevention of mental illness, emotional, or behavioral disturbances. Jesse Wayne Coburn, LSCW, CADC II, SUDP NPI is 1902463086. The provider is registered as an individual entity type.
The NPPES NPI record indicates the provider is a male.
The provider's business location address is:
7309 BALMER ST
HILL AFB, UT
ZIP 84056-012
Phone: (801) 777-7909
The NPI 1902463086 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.
The following top HCPCS codes were publicly reported for this provider under the Medicare program for the year 2016. The reported codes are based on the top codes for each available Medicare specialty, excluding evaluation and management codes.
- Psychiatric diagnostic evaluation (HCPCS:90791)
The enumeration date for this NPI number is 5/23/2019 and was last updated on 3/26/2024.
Taxonomy Codes
The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:
No. |
Taxonomy Code |
Taxonomy Clasification |
Taxonomy Specialization |
License Number |
License State |
Primary |
1 | 101YA0400X | Counselor | Addiction (Substance Use Disorder) | LW61327515 | WASHINGTON | No |
2 | 101YA0400X | Counselor | Addiction (Substance Use Disorder) | | | No |
3 | 101YM0800X | Counselor | Mental Health | 13486284-3501 | UTAH | No |
4 | 101YM0800X | Counselor | Mental Health | A5574 | OREGON | No |
5 | 1041C0700X | Social Worker | Clinical | 13486284-3501 | UTAH | Yes |