Provider Demographics
NPI:1184380974
Name:SIXBEY, JACQUELINE (LPC)
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:
Last Name:SIXBEY
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:862 HERITAGE RD
Mailing Address - Street 2:
Mailing Address - City:LANDER
Mailing Address - State:WY
Mailing Address - Zip Code:82520-8930
Mailing Address - Country:US
Mailing Address - Phone:307-277-1408
Mailing Address - Fax:
Practice Address - Street 1:862 HERITAGE RD
Practice Address - Street 2:
Practice Address - City:LANDER
Practice Address - State:WY
Practice Address - Zip Code:82520-8930
Practice Address - Country:US
Practice Address - Phone:307-277-1408
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-16
Last Update Date:2021-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYLPC2006101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional