Provider Demographics
NPI:1093082711
Name:LUGO, JACQUELINE KAY (LMFT)
Entity Type:Individual
Prefix:MRS
First Name:JACQUELINE
Middle Name:KAY
Last Name:LUGO
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31897 DEL OBISPO ST
Mailing Address - Street 2:STE 250
Mailing Address - City:SAN JUAN CAPISTRANO
Mailing Address - State:CA
Mailing Address - Zip Code:92675-3207
Mailing Address - Country:US
Mailing Address - Phone:929-441-0711
Mailing Address - Fax:
Practice Address - Street 1:31897 DEL OBISPO ST
Practice Address - Street 2:STE 250
Practice Address - City:SAN JUAN CAPISTRANO
Practice Address - State:CA
Practice Address - Zip Code:92675-3207
Practice Address - Country:US
Practice Address - Phone:929-441-0711
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-23
Last Update Date:2016-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA74393101YM0800X
CA91280106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health