Provider Demographics
NPI:1316586258
Name:HUNTER, JACLYN SUZANNE (MA, LMFT 88831)
Entity Type:Individual
Prefix:
First Name:JACLYN
Middle Name:SUZANNE
Last Name:HUNTER
Suffix:
Gender:F
Credentials:MA, LMFT 88831
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:603 N CLEVELAND ST APT E
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92054-2467
Mailing Address - Country:US
Mailing Address - Phone:760-712-7941
Mailing Address - Fax:
Practice Address - Street 1:2204 S EL CAMINO REAL STE 315
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92054-6390
Practice Address - Country:US
Practice Address - Phone:760-696-7550
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-23
Last Update Date:2019-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA88831106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty