Provider Demographics
NPI:1033990379
Name:HARRIS, JACQUELYN PATRICIA (MA,LPCC)
Entity Type:Individual
Prefix:MS
First Name:JACQUELYN
Middle Name:PATRICIA
Last Name:HARRIS
Suffix:
Gender:F
Credentials:MA,LPCC
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 616
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:CO
Mailing Address - Zip Code:80530-0616
Mailing Address - Country:US
Mailing Address - Phone:281-300-1836
Mailing Address - Fax:
Practice Address - Street 1:640 MAIN STREET
Practice Address - Street 2:UNIT D
Practice Address - City:FREDERICK
Practice Address - State:CO
Practice Address - Zip Code:80530
Practice Address - Country:US
Practice Address - Phone:281-300-1836
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-12
Last Update Date:2023-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLPCC.0018622101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health