Provider Demographics
NPI:1497476667
Name:CAZARES, JAQUELIN
Entity Type:Individual
Prefix:
First Name:JAQUELIN
Middle Name:
Last Name:CAZARES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2300 CLEAR CREEK RD STE 203
Mailing Address - Street 2:
Mailing Address - City:KILLEEN
Mailing Address - State:TX
Mailing Address - Zip Code:76549-5404
Mailing Address - Country:US
Mailing Address - Phone:254-433-5349
Mailing Address - Fax:817-562-8222
Practice Address - Street 1:2300 CLEAR CREEK RD STE 203
Practice Address - Street 2:
Practice Address - City:KILLEEN
Practice Address - State:TX
Practice Address - Zip Code:76549-5404
Practice Address - Country:US
Practice Address - Phone:542-433-5349
Practice Address - Fax:817-562-8222
Is Sole Proprietor?:No
Enumeration Date:2022-09-07
Last Update Date:2023-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X
NMRBT-23-256220106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician