Provider Demographics
NPI:1164746491
Name:ENGELHARDT, JACKIE J (MS, LMFT-A, LPC-I)
Entity Type:Individual
Prefix:
First Name:JACKIE
Middle Name:J
Last Name:ENGELHARDT
Suffix:
Gender:F
Credentials:MS, LMFT-A, LPC-I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:738 PINEHURST DR
Mailing Address - Street 2:
Mailing Address - City:NEW BRAUNFELS
Mailing Address - State:TX
Mailing Address - Zip Code:78130-2449
Mailing Address - Country:US
Mailing Address - Phone:936-442-0680
Mailing Address - Fax:
Practice Address - Street 1:187 ELMHURST
Practice Address - Street 2:SUITE A
Practice Address - City:KYLE
Practice Address - State:TX
Practice Address - Zip Code:78640-6115
Practice Address - Country:US
Practice Address - Phone:512-318-2661
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-15
Last Update Date:2010-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX66132101YP2500X
TX201340106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional