Provider Demographics
NPI:1124373188
Name:STRAIT, JACQUELYN MONIQUE (PHD)
Entity Type:Individual
Prefix:
First Name:JACQUELYN
Middle Name:MONIQUE
Last Name:STRAIT
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1506 E WINDING WAY DR STE 606
Mailing Address - Street 2:
Mailing Address - City:FRIENDSWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:77546-5398
Mailing Address - Country:US
Mailing Address - Phone:281-816-6460
Mailing Address - Fax:281-754-4985
Practice Address - Street 1:1506 E WINDING WAY DR STE 606
Practice Address - Street 2:
Practice Address - City:FRIENDSWOOD
Practice Address - State:TX
Practice Address - Zip Code:77546-5398
Practice Address - Country:US
Practice Address - Phone:281-816-6460
Practice Address - Fax:281-754-4985
Is Sole Proprietor?:No
Enumeration Date:2012-07-16
Last Update Date:2018-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX36133103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist