Provider Demographics
NPI:1063043024
Name:HIDALGO, JACQUELYN LEE (LPC)
Entity Type:Individual
Prefix:
First Name:JACQUELYN
Middle Name:LEE
Last Name:HIDALGO
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 1:107 SPANISH OAK DR
Mailing Address - Street 2:
Mailing Address - City:CARENCRO
Mailing Address - State:LA
Mailing Address - Zip Code:70520-5778
Mailing Address - Country:US
Mailing Address - Phone:337-255-5313
Mailing Address - Fax:
Practice Address - Street 1:333 S MAIN ST
Practice Address - Street 2:
Practice Address - City:OPELOUSAS
Practice Address - State:LA
Practice Address - Zip Code:70570-6137
Practice Address - Country:US
Practice Address - Phone:337-945-1032
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-29
Last Update Date:2020-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA6940101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional