Provider Demographics
NPI:1265827836
Name:BABCOCK, JACQUELINE PAIGE (LMFT)
Entity Type:Individual
Prefix:MRS
First Name:JACQUELINE
Middle Name:PAIGE
Last Name:BABCOCK
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:MISS
Other - First Name:JACQUELINE
Other - Middle Name:PAIGE
Other - Last Name:SULLIVAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:837 S LAPEER RD
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48371-5084
Mailing Address - Country:US
Mailing Address - Phone:480-248-0770
Mailing Address - Fax:
Practice Address - Street 1:837 S LAPEER RD
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:MI
Practice Address - Zip Code:48371-5084
Practice Address - Country:US
Practice Address - Phone:480-248-0770
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-31
Last Update Date:2019-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLMFT-15179106H00000X
AZLAMFT-10431106H00000X
MI4101006785106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist