Provider Demographics
NPI:1063962306
Name:MCKAIN, JACQUELYN (BS, QMHP)
Entity type:Individual
Prefix:
First Name:JACQUELYN
Middle Name:
Last Name:MCKAIN
Suffix:
Gender:F
Credentials:BS, QMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:222 SIDNEY BAKER ST S
Mailing Address - Street 2:SUITE 435
Mailing Address - City:KERRVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78028-5994
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:888 S GREENVILLE AVE
Practice Address - Street 2:STE 127
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75081-5058
Practice Address - Country:US
Practice Address - Phone:972-776-6684
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-11
Last Update Date:2016-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health