Provider Demographics
NPI:1073268496
Name:NEWELL, JACLYN MARIE (AMFT, APCC)
Entity type:Individual
Prefix:
First Name:JACLYN
Middle Name:MARIE
Last Name:NEWELL
Suffix:
Gender:F
Credentials:AMFT, APCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1080 8TH AVE UNIT 1319
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92101-5573
Mailing Address - Country:US
Mailing Address - Phone:661-364-3431
Mailing Address - Fax:
Practice Address - Street 1:9888 CARROLL CENTRE RD STE 216
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92126-4515
Practice Address - Country:US
Practice Address - Phone:858-413-7557
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-14
Last Update Date:2022-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YP2500X
CA106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional