Provider Demographics
NPI:1033651179
Name:BERKE, JACQUELYN S (LPC)
Entity Type:Individual
Prefix:
First Name:JACQUELYN
Middle Name:S
Last Name:BERKE
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 1:420 W 2ND ST
Mailing Address - Street 2:
Mailing Address - City:SIOUX CITY
Mailing Address - State:IA
Mailing Address - Zip Code:51103-4506
Mailing Address - Country:US
Mailing Address - Phone:712-600-4838
Mailing Address - Fax:
Practice Address - Street 1:420 W 2ND ST
Practice Address - Street 2:
Practice Address - City:SIOUX CITY
Practice Address - State:IA
Practice Address - Zip Code:51103-4506
Practice Address - Country:US
Practice Address - Phone:712-600-4838
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-07
Last Update Date:2023-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA20006101YA0400X
NE1329101YA0400X
IA083744101YM0800X
NE2277101YM0800X
NE2548101YP2500X
SD30775101YP2500X
NE11038101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional