Provider Demographics
NPI:1154053171
Name:NAVARRETE, JACQUELINE (LMFT)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:
Last Name:NAVARRETE
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 1:358 N MAIN ST STE 300
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67202-1511
Mailing Address - Country:US
Mailing Address - Phone:316-351-7644
Mailing Address - Fax:316-351-7689
Practice Address - Street 1:358 N MAIN ST STE 300
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67202-1511
Practice Address - Country:US
Practice Address - Phone:316-351-7644
Practice Address - Fax:316-351-7689
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-28
Last Update Date:2022-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS03375104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty