Provider Demographics
NPI:1336907484
Name:MCDONALD, JACQUELYN RENEE (DSW, AMFT, APCC)
Entity Type:Individual
Prefix:MRS
First Name:JACQUELYN
Middle Name:RENEE
Last Name:MCDONALD
Suffix:
Gender:F
Credentials:DSW, AMFT, APCC
Other - Prefix:DR
Other - First Name:JACQUELYN
Other - Middle Name:RENEE
Other - Last Name:MCDONALD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DSW, AMFT, APCC
Mailing Address - Street 1:PO BOX 1134
Mailing Address - Street 2:
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92564-1134
Mailing Address - Country:US
Mailing Address - Phone:951-210-2142
Mailing Address - Fax:
Practice Address - Street 1:1096 CALIMESA BLVD
Practice Address - Street 2:
Practice Address - City:CALIMESA
Practice Address - State:CA
Practice Address - Zip Code:92320-1563
Practice Address - Country:US
Practice Address - Phone:909-372-0683
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-12
Last Update Date:2024-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No104100000XBehavioral Health & Social Service ProvidersSocial Worker