Provider Demographics
NPI:1588191282
Name:CHANEY, JACQUELINE (LMHC, NCC, PHD)
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:
Last Name:CHANEY
Suffix:
Gender:F
Credentials:LMHC, NCC, PHD
Other - Prefix:
Other - First Name:JACQUELINE
Other - Middle Name:LASHUN
Other - Last Name:CHANEY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA, LMHC, NCC, PHD
Mailing Address - Street 1:4121 ARBOR DR SE
Mailing Address - Street 2:
Mailing Address - City:LACEY
Mailing Address - State:WA
Mailing Address - Zip Code:98503-4097
Mailing Address - Country:US
Mailing Address - Phone:360-491-0366
Mailing Address - Fax:
Practice Address - Street 1:4121 ARBOR DR SE
Practice Address - Street 2:
Practice Address - City:LACEY
Practice Address - State:WA
Practice Address - Zip Code:98503-4097
Practice Address - Country:US
Practice Address - Phone:360-491-0366
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-12
Last Update Date:2024-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH60649663101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health