Provider Demographics
NPI:1134459290
Name:HATTEN, JACQUELINE ALEXIS (LPCC-S)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:ALEXIS
Last Name:HATTEN
Suffix:
Gender:F
Credentials:LPCC-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8316 BRUNTSFIELD RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43235-8425
Mailing Address - Country:US
Mailing Address - Phone:614-657-5225
Mailing Address - Fax:
Practice Address - Street 1:453 ALLENBY DR
Practice Address - Street 2:
Practice Address - City:MARYSVILLE
Practice Address - State:OH
Practice Address - Zip Code:43040-8722
Practice Address - Country:US
Practice Address - Phone:937-642-0048
Practice Address - Fax:937-642-1316
Is Sole Proprietor?:No
Enumeration Date:2010-01-12
Last Update Date:2010-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE.0007661-SUPR101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor