Provider Demographics
NPI:1508162934
Name:MACK, JACQUELINE K (LPC)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:K
Last Name:MACK
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16242 HOLLOW WOOD DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77090-4722
Mailing Address - Country:US
Mailing Address - Phone:832-768-1673
Mailing Address - Fax:
Practice Address - Street 1:3845 CYPRESS CREEK PKWY STE 265
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77068-3574
Practice Address - Country:US
Practice Address - Phone:281-355-0905
Practice Address - Fax:281-817-7460
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-02
Last Update Date:2023-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX67371101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional