Provider Demographics
NPI:1295606275
Name:HARTL, JACLYN (MED, LPC - S)
Entity type:Individual
Prefix:
First Name:JACLYN
Middle Name:
Last Name:HARTL
Suffix:
Gender:F
Credentials:MED, LPC - S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5415 STATE HIGHWAY 35 S
Mailing Address - Street 2:
Mailing Address - City:PORT LAVACA
Mailing Address - State:TX
Mailing Address - Zip Code:77979-5730
Mailing Address - Country:US
Mailing Address - Phone:361-648-2026
Mailing Address - Fax:
Practice Address - Street 1:5415 STATE HIGHWAY 35 S
Practice Address - Street 2:
Practice Address - City:PORT LAVACA
Practice Address - State:TX
Practice Address - Zip Code:77979-5730
Practice Address - Country:US
Practice Address - Phone:361-648-2026
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-15
Last Update Date:2025-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX80869101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional