Provider Demographics
NPI:1245852276
Name:VAN HORN, JACKOLYN MARIE (MED, LPCC)
Entity type:Individual
Prefix:
First Name:JACKOLYN
Middle Name:MARIE
Last Name:VAN HORN
Suffix:
Gender:F
Credentials:MED, LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:611 HIGH ST NW
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:OH
Mailing Address - Zip Code:44615-1117
Mailing Address - Country:US
Mailing Address - Phone:330-627-3954
Mailing Address - Fax:330-627-3984
Practice Address - Street 1:611 HIGH ST NW
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:OH
Practice Address - Zip Code:44615-1117
Practice Address - Country:US
Practice Address - Phone:330-627-3954
Practice Address - Fax:330-627-3984
Is Sole Proprietor?:No
Enumeration Date:2020-05-13
Last Update Date:2025-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE.2404325-SUPV101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health