Provider Demographics
NPI:1184053514
Name:KURTZ, JACQUELYNE MARISA (MA, LPC)
Entity type:Individual
Prefix:MRS
First Name:JACQUELYNE
Middle Name:MARISA
Last Name:KURTZ
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 425
Mailing Address - Street 2:
Mailing Address - City:EL CAMPO
Mailing Address - State:TX
Mailing Address - Zip Code:77437-0425
Mailing Address - Country:US
Mailing Address - Phone:979-616-1760
Mailing Address - Fax:
Practice Address - Street 1:245 COMMERCE GREEN BLVD
Practice Address - Street 2:STE 130
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77478-3674
Practice Address - Country:US
Practice Address - Phone:979-616-1760
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-11-06
Last Update Date:2013-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX63909101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional