Provider Demographics
NPI:1912001546
Name:MAUCK, JARRED BRECK (BA,MHP)
Entity Type:Individual
Prefix:
First Name:JARRED
Middle Name:BRECK
Last Name:MAUCK
Suffix:
Gender:M
Credentials:BA,MHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2119 1/2 HAMPSHIRE ST
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:IL
Mailing Address - Zip Code:62301-3149
Mailing Address - Country:US
Mailing Address - Phone:217-223-0413
Mailing Address - Fax:
Practice Address - Street 1:4409 MAINE ST
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:IL
Practice Address - Zip Code:62305-5849
Practice Address - Country:US
Practice Address - Phone:217-223-0423
Practice Address - Fax:217-223-0461
Is Sole Proprietor?:No
Enumeration Date:2006-09-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor