Provider Demographics
NPI:1134736234
Name:JAECKLE, COURTNEY D (MA, LPC)
Entity type:Individual
Prefix:
First Name:COURTNEY
Middle Name:D
Last Name:JAECKLE
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 155
Mailing Address - Street 2:
Mailing Address - City:ROYSE CITY
Mailing Address - State:TX
Mailing Address - Zip Code:75189-0155
Mailing Address - Country:US
Mailing Address - Phone:214-415-5123
Mailing Address - Fax:
Practice Address - Street 1:6373 COUNTY ROAD 2520
Practice Address - Street 2:
Practice Address - City:ROYSE CITY
Practice Address - State:TX
Practice Address - Zip Code:75189-8017
Practice Address - Country:US
Practice Address - Phone:323-639-8463
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-23
Last Update Date:2023-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX78798101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health