Provider Demographics
NPI:1588019301
Name:NEWMAN, JACKIE F (LPCC)
Entity Type:Individual
Prefix:MRS
First Name:JACKIE
Middle Name:F
Last Name:NEWMAN
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 1:1830 DESTINY LN STE 107
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42104-1088
Mailing Address - Country:US
Mailing Address - Phone:270-302-4851
Mailing Address - Fax:
Practice Address - Street 1:1830 DESTINY LN STE 107
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42104-1088
Practice Address - Country:US
Practice Address - Phone:270-302-4851
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-29
Last Update Date:2016-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYLPCPCC00225634101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional