Provider Demographics
NPI:1326750761
Name:BAILES, JACLYN POE (LPC-ASSOCIATE)
Entity Type:Individual
Prefix:
First Name:JACLYN
Middle Name:POE
Last Name:BAILES
Suffix:
Gender:F
Credentials:LPC-ASSOCIATE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:202 PRIVATE ROAD 1280
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:75840-5188
Mailing Address - Country:US
Mailing Address - Phone:903-948-8038
Mailing Address - Fax:
Practice Address - Street 1:510 AUSTIN AVE
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76701-2107
Practice Address - Country:US
Practice Address - Phone:903-948-8038
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-16
Last Update Date:2022-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX90524101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional