Provider Demographics
NPI:1184908543
Name:SPENGLER, JACQUELINE ZETA (LMFT, BCBA)
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:ZETA
Last Name:SPENGLER
Suffix:
Gender:F
Credentials:LMFT, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2901 CARMELLA WAY
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95355-9137
Mailing Address - Country:US
Mailing Address - Phone:209-672-5590
Mailing Address - Fax:
Practice Address - Street 1:2020 COFFEE RD STE H6
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95355-2416
Practice Address - Country:US
Practice Address - Phone:209-672-5590
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-04
Last Update Date:2021-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YP2500X
1-14-10387103K00000X
CA95748106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst