Provider Demographics
NPI:1689268864
Name:COUGHLIN, JACQUELYN (LPC)
Entity Type:Individual
Prefix:
First Name:JACQUELYN
Middle Name:
Last Name:COUGHLIN
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 1:237 W BERWICK ST
Mailing Address - Street 2:
Mailing Address - City:EASTON
Mailing Address - State:PA
Mailing Address - Zip Code:18042-6633
Mailing Address - Country:US
Mailing Address - Phone:610-972-3560
Mailing Address - Fax:
Practice Address - Street 1:237 W BERWICK ST
Practice Address - Street 2:
Practice Address - City:EASTON
Practice Address - State:PA
Practice Address - Zip Code:18042-6633
Practice Address - Country:US
Practice Address - Phone:610-972-3560
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-27
Last Update Date:2021-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC013036101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health