Provider Demographics
NPI:1245801919
Name:HYNES, JACQUELINE (LPC, LCDC)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:
Last Name:HYNES
Suffix:
Gender:F
Credentials:LPC, LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2402 CORDOBA DR APT B
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75006-7879
Mailing Address - Country:US
Mailing Address - Phone:940-435-8317
Mailing Address - Fax:
Practice Address - Street 1:2402 CORDOBA DR APT B
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75006-7879
Practice Address - Country:US
Practice Address - Phone:940-435-8317
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-05
Last Update Date:2022-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX15641101YA0400X
TX85786101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)