Provider Demographics
NPI:1487045456
Name:MARCELLE, JAMAEL (MS, LPC)
Entity type:Individual
Prefix:
First Name:JAMAEL
Middle Name:
Last Name:MARCELLE
Suffix:
Gender:F
Credentials:MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 8266
Mailing Address - Street 2:
Mailing Address - City:WICHITA FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:76307-8266
Mailing Address - Country:US
Mailing Address - Phone:940-696-6214
Mailing Address - Fax:940-696-6210
Practice Address - Street 1:1709 10TH ST
Practice Address - Street 2:
Practice Address - City:WICHITA FALLS
Practice Address - State:TX
Practice Address - Zip Code:76301-5010
Practice Address - Country:US
Practice Address - Phone:940-696-6214
Practice Address - Fax:940-696-6210
Is Sole Proprietor?:No
Enumeration Date:2015-02-12
Last Update Date:2017-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX32617101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health