Provider Demographics
NPI:1083062665
Name:KATZ, JACQUELINE DIANE (LPC, LCDC)
Entity Type:Individual
Prefix:MS
First Name:JACQUELINE
Middle Name:DIANE
Last Name:KATZ
Suffix:
Gender:F
Credentials:LPC, LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:441 TIFFANY TRL
Mailing Address - Street 2:
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75081-5544
Mailing Address - Country:US
Mailing Address - Phone:214-714-6618
Mailing Address - Fax:
Practice Address - Street 1:1445 MAC ARTHUR DR
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75007-4461
Practice Address - Country:US
Practice Address - Phone:214-714-6618
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-24
Last Update Date:2016-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12426101YA0400X
TX71004101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)