Provider Demographics
NPI:1407289713
Name:MARCUM, JACQUELYN SUE (LMHC)
Entity Type:Individual
Prefix:MS
First Name:JACQUELYN
Middle Name:SUE
Last Name:MARCUM
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3003 GROVER AVE
Mailing Address - Street 2:
Mailing Address - City:MISSOURI VALLEY
Mailing Address - State:IA
Mailing Address - Zip Code:51555-7020
Mailing Address - Country:US
Mailing Address - Phone:402-980-8266
Mailing Address - Fax:712-256-9661
Practice Address - Street 1:427 E KANESVILLE BLVD
Practice Address - Street 2:
Practice Address - City:COUNCIL BLUFFS
Practice Address - State:IA
Practice Address - Zip Code:51503-9079
Practice Address - Country:US
Practice Address - Phone:712-256-9660
Practice Address - Fax:712-256-9661
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-11
Last Update Date:2013-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA001619101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health