Provider Demographics
NPI:1245972405
Name:SCHAEFER, JACQUELYN KAY (LADAC LMHC)
Entity type:Individual
Prefix:MRS
First Name:JACQUELYN
Middle Name:KAY
Last Name:SCHAEFER
Suffix:
Gender:F
Credentials:LADAC LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3908 CARLISLE BLVD NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87107-4504
Mailing Address - Country:US
Mailing Address - Phone:505-243-2223
Mailing Address - Fax:
Practice Address - Street 1:3908 CARLISLE BLVD NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87107-4504
Practice Address - Country:US
Practice Address - Phone:505-243-2223
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-08
Last Update Date:2022-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMCMH0165681101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional