Provider Demographics
NPI:1720599384
Name:SPILLER, JACQUELINE ANNETTE (LPC, LCDC)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:ANNETTE
Last Name:SPILLER
Suffix:
Gender:F
Credentials:LPC, LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2001 E SPRING CREEK PKWY APT 9101
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75074-3240
Mailing Address - Country:US
Mailing Address - Phone:214-924-1855
Mailing Address - Fax:
Practice Address - Street 1:550 S WATTERS RD STE 145
Practice Address - Street 2:
Practice Address - City:ALLEN
Practice Address - State:TX
Practice Address - Zip Code:75013-5226
Practice Address - Country:US
Practice Address - Phone:214-924-1855
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-22
Last Update Date:2019-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX76421101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00S377OtherBLUE CROSS BLUE SHIELD TEXAS (BCBSTX)