Provider Demographics
NPI:1861846701
Name:WERBOFF-THURSTON, JACLYN RUTH (LMHC)
Entity Type:Individual
Prefix:
First Name:JACLYN
Middle Name:RUTH
Last Name:WERBOFF-THURSTON
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:JACLYN
Other - Middle Name:
Other - Last Name:WERBOFF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2450 OLD MOULTRIE ROAD
Mailing Address - Street 2:SUITE 301
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32086
Mailing Address - Country:US
Mailing Address - Phone:904-257-5025
Mailing Address - Fax:
Practice Address - Street 1:2450 OLD MOULTRIE ROAD
Practice Address - Street 2:SUITE 301
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32086
Practice Address - Country:US
Practice Address - Phone:904-257-5025
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-18
Last Update Date:2024-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH16535101YM0800X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health