Provider Demographics
NPI:1841600319
Name:JEFFRIES, JACQUELINE (DBH, LISAC)
Entity Type:Individual
Prefix:DR
First Name:JACQUELINE
Middle Name:
Last Name:JEFFRIES
Suffix:
Gender:F
Credentials:DBH, LISAC
Other - Prefix:MRS
Other - First Name:JACQUELINE
Other - Middle Name:
Other - Last Name:JEFFRIES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DBH, LISAC
Mailing Address - Street 1:3736 E ISABELLA AVE
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85206-3803
Mailing Address - Country:US
Mailing Address - Phone:480-455-0915
Mailing Address - Fax:480-212-0924
Practice Address - Street 1:201 W GUADALUPE RD STE 301
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85233-3333
Practice Address - Country:US
Practice Address - Phone:480-455-0915
Practice Address - Fax:480-212-0924
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-05
Last Update Date:2014-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLISAC-11894101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)