Provider Demographics
NPI:1780195396
Name:FELIX, JACLYN SUZETTE (LPC, LMHC)
Entity Type:Individual
Prefix:
First Name:JACLYN
Middle Name:SUZETTE
Last Name:FELIX
Suffix:
Gender:F
Credentials:LPC, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7401 ANSLEY DR
Mailing Address - Street 2:
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33467-7708
Mailing Address - Country:US
Mailing Address - Phone:561-464-0612
Mailing Address - Fax:
Practice Address - Street 1:420 S STATE ROAD 7
Practice Address - Street 2:
Practice Address - City:WELLINGTON
Practice Address - State:FL
Practice Address - Zip Code:33414-4303
Practice Address - Country:US
Practice Address - Phone:561-223-1066
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-23
Last Update Date:2022-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC009912101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional