Provider Demographics
NPI:1467173971
Name:JACLYN MOURAS, PSYD, PLLC
Entity Type:Organization
Organization Name:JACLYN MOURAS, PSYD, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING CONTROL
Authorized Official - Prefix:
Authorized Official - First Name:JACLYN
Authorized Official - Middle Name:
Authorized Official - Last Name:MOURAS
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:484-883-4923
Mailing Address - Street 1:81 BROAD ST
Mailing Address - Street 2:
Mailing Address - City:HARRISONBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22802-4119
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:27 STONERIDGE DR STE A01
Practice Address - Street 2:
Practice Address - City:WAYNESBORO
Practice Address - State:VA
Practice Address - Zip Code:22980-6583
Practice Address - Country:US
Practice Address - Phone:540-221-1846
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-05
Last Update Date:2022-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1639805708OtherNPI