JACOB JOSEPH GORDON GRAHAM
NPI 1861191330
Marriage & Family Therapist in Pasadena, CA

Q: What is Jacob Graham's NPI number?

The NPI number for Jacob Graham is 1861191330. It was assigned to this individual provider in the NPPES registry on February 23, 2023.

Q: What is Jacob Graham's specialty?

The primary specialty registered for this NPI is Marriage & Family Therapist with taxonomy code 106H00000X.

Q: Is Jacob Graham enrolled in Medicare?

No. Jacob Graham has opted out of Medicare through February 19, 2027. Care is provided under private contracts, and Medicare does not pay for services furnished by providers who have opted out.

Q: When was this NPI record last updated?

The NPPES record for Jacob Graham was last updated on February 23, 2023. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 3 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.

Active since February 23, 2023Opted out of Medicare · through Feb 19, 2027

650 SIERRA MADRE VILLA AVE STE 110, PASADENA, CA 91107(626) 351-9616(626) 351-9493 Get Directions Write a Review

NPPES record last updated: February 23, 2023. Verified against the NPPES registry weekly; last sync: August 30, 2026.

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About Jacob Joseph Gordon Graham NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

JACOB JOSEPH GORDON GRAHAM (NPI 1861191330) is an individual marriage & family therapist in Pasadena, California, licensed in California (135841) and active in the NPI registry since February 2023. He has opted out of Medicare through February 19, 2027.

NPPES Registry Identity

NPI1861191330

Entity TypeIndividualMale

Primary Taxonomy106H00000X

Provider Legal NameJACOB JOSEPH GORDON GRAHAM

Location Address650 SIERRA MADRE VILLA AVE STE 110Pasadena, CA 91107-2040

Mailing Address650 Sierra Madre Villa Ave Ste 110Pasadena, CA 91107-2040 · (714) 493-2742 · Fax (626) 351-9493

Phone(626) 351-9616

Fax(626) 351-9493

Sole ProprietorNo

Enumeration DateFebruary 23, 2023

NPPES CertifiedFebruary 23, 2023

✔ NPI 1861191330 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyMarriage & Family TherapistBehavioral Health & Social Service Providers

Taxonomy Code106H00000X

License✔ Licensed in CA · 135841

Definition

A marriage and family therapist is a person with a master's degree in marriage and family therapy, or a master's or doctoral degree in a related mental health field with substantially equivalent coursework in marriage and family therapy, who receives supervised clinical experience, or a person who meets the state requirements to practice as a marriage and family therapist. A marriage and family therapist treats mental and emotional disorders within the context of marriage and family systems. A marriage and family therapist provides mental health and counseling services to individuals, couples, families, and groups.

650 SIERRA MADRE VILLA AVE STE 110, Pasadena, CA 91107

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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

ⓘ

Opted out of Medicare

Jacob Joseph Gordon Graham has filed a Medicare opt-out affidavit. Services are provided under private contract between the provider and the patient, and are not billed to or reimbursed by Medicare. The opt-out is on file from February 19, 2025 through February 19, 2027.

Opt-Out Effective DateFebruary 19, 2025

Opt-Out In Effect ThroughFebruary 19, 2027Opt-out affidavits renew automatically every two years unless cancelled

Other Providers at the Same Location NPPES 12

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

DR. ANDREA FORBES PSY.D.

Psychologist (Clinical)