Provider Demographics
NPI:1952461469
Name:HAM, JACQUELINE A (LMHC)
Entity Type:Individual
Prefix:MS
First Name:JACQUELINE
Middle Name:A
Last Name:HAM
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8501 N 50TH ST
Mailing Address - Street 2:201
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33617-6100
Mailing Address - Country:US
Mailing Address - Phone:813-635-9765
Mailing Address - Fax:813-635-9725
Practice Address - Street 1:1911 N US HIGHWAY 301
Practice Address - Street 2:200
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33619-2642
Practice Address - Country:US
Practice Address - Phone:813-635-9765
Practice Address - Fax:813-635-9725
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH2954101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health