Provider Demographics
NPI:1558701581
Name:BAINBRIDGE, JACQUELYN SCHNEIDER (LPCC)
Entity Type:Individual
Prefix:MRS
First Name:JACQUELYN
Middle Name:SCHNEIDER
Last Name:BAINBRIDGE
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 PORTAGE PL
Mailing Address - Street 2:
Mailing Address - City:JEFFERSONVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47130-5782
Mailing Address - Country:US
Mailing Address - Phone:502-445-8376
Mailing Address - Fax:502-451-4754
Practice Address - Street 1:30 PORTAGE PLACE
Practice Address - Street 2:
Practice Address - City:JEFFERSONVILLE
Practice Address - State:IN
Practice Address - Zip Code:47130-4031
Practice Address - Country:US
Practice Address - Phone:502-445-8376
Practice Address - Fax:502-451-4754
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-05
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYLPCPCC00223151101YP2500X
KY166996101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional