Provider Demographics
NPI:1588392575
Name:JACKLYN POWERS, LLC
Entity type:Organization
Organization Name:JACKLYN POWERS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED MENTAL HEALTH COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:JACKLYN
Authorized Official - Middle Name:
Authorized Official - Last Name:POWERRS
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:781-462-1019
Mailing Address - Street 1:11C FILLMORE RD
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:MA
Mailing Address - Zip Code:01970-2700
Mailing Address - Country:US
Mailing Address - Phone:781-715-5522
Mailing Address - Fax:
Practice Address - Street 1:11C FILLMORE RD
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:MA
Practice Address - Zip Code:01970-2700
Practice Address - Country:US
Practice Address - Phone:781-715-5522
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-09
Last Update Date:2022-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1689230781OtherOPTUM