Provider Demographics
NPI:1295566354
Name:KLASSEN, JACQUELINE (LPC-A)
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:
Last Name:KLASSEN
Suffix:
Gender:F
Credentials:LPC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:918 S TRAVIS ST
Mailing Address - Street 2:
Mailing Address - City:SHERMAN
Mailing Address - State:TX
Mailing Address - Zip Code:75090-7920
Mailing Address - Country:US
Mailing Address - Phone:903-421-6950
Mailing Address - Fax:
Practice Address - Street 1:804 PECAN GROVE RD E
Practice Address - Street 2:
Practice Address - City:SHERMAN
Practice Address - State:TX
Practice Address - Zip Code:75090-1767
Practice Address - Country:US
Practice Address - Phone:903-893-7768
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-12
Last Update Date:2024-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9547101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional