Provider Demographics
NPI:1285385385
Name:JUAREZ, JACQUELINE ANN (LPC)
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:ANN
Last Name:JUAREZ
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5409 MARYLAND WAY STE 202
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-1084
Mailing Address - Country:US
Mailing Address - Phone:615-373-9955
Mailing Address - Fax:
Practice Address - Street 1:5409 MARYLAND WAY STE 202
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:TN
Practice Address - Zip Code:37027-1084
Practice Address - Country:US
Practice Address - Phone:615-373-9955
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-11
Last Update Date:2022-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNPLC0000005254101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNLPC0000005254OtherLPC