Provider Demographics
NPI:1710466552
Name:JURY, JACQUELYNN M (LPC)
Entity Type:Individual
Prefix:
First Name:JACQUELYNN
Middle Name:M
Last Name:JURY
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 1:551 THOROUGHBRED DR
Mailing Address - Street 2:
Mailing Address - City:CHARLES TOWN
Mailing Address - State:WV
Mailing Address - Zip Code:25414-3751
Mailing Address - Country:US
Mailing Address - Phone:304-240-8460
Mailing Address - Fax:
Practice Address - Street 1:312 S CAMERON ST STE B
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:VA
Practice Address - Zip Code:22601-4603
Practice Address - Country:US
Practice Address - Phone:540-486-4653
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-13
Last Update Date:2018-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701007092101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional