Provider Demographics
NPI:1073876132
Name:STRAUB, JACQUELYN (LPC)
Entity Type:Individual
Prefix:MRS
First Name:JACQUELYN
Middle Name:
Last Name:STRAUB
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 1:100 PENNSYLVANIA AVE
Mailing Address - Street 2:SUITE #3
Mailing Address - City:IRWIN
Mailing Address - State:PA
Mailing Address - Zip Code:15642-3552
Mailing Address - Country:US
Mailing Address - Phone:412-610-5032
Mailing Address - Fax:
Practice Address - Street 1:100 PENNSYLVANIA AVE
Practice Address - Street 2:
Practice Address - City:IRWIN
Practice Address - State:PA
Practice Address - Zip Code:15642-3552
Practice Address - Country:US
Practice Address - Phone:724-863-0760
Practice Address - Fax:724-863-0766
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-22
Last Update Date:2015-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC006407101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional