Provider Demographics
NPI:1306328927
Name:PICKENS, JACLYN DANIELLE CRAVENS (LMFT-A)
Entity type:Individual
Prefix:DR
First Name:JACLYN
Middle Name:DANIELLE CRAVENS
Last Name:PICKENS
Suffix:
Gender:F
Credentials:LMFT-A
Other - Prefix:DR
Other - First Name:JACLYN
Other - Middle Name:DANIELLE
Other - Last Name:CRAVENS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMFTA
Mailing Address - Street 1:8212 ITHACA AVE STE E12
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79423-2615
Mailing Address - Country:US
Mailing Address - Phone:252-702-9277
Mailing Address - Fax:
Practice Address - Street 1:8212 ITHACA AVE STE E12
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79423-2615
Practice Address - Country:US
Practice Address - Phone:252-702-9277
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-30
Last Update Date:2018-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX202702106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist