Provider Demographics
NPI:1669740411
Name:SCOTT, JACKIE L (LPC-S, LCPC-S)
Entity type:Individual
Prefix:MRS
First Name:JACKIE
Middle Name:L
Last Name:SCOTT
Suffix:
Gender:F
Credentials:LPC-S, LCPC-S
Other - Prefix:MISS
Other - First Name:JACKIE
Other - Middle Name:L
Other - Last Name:HANSELMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC-S, LCPC-S
Mailing Address - Street 1:201 N PENN AVE STE 405
Mailing Address - Street 2:
Mailing Address - City:INDEPENDENCE
Mailing Address - State:KS
Mailing Address - Zip Code:67301-3354
Mailing Address - Country:US
Mailing Address - Phone:620-688-6595
Mailing Address - Fax:888-975-3464
Practice Address - Street 1:201 N PENN AVE STE 405
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:KS
Practice Address - Zip Code:67301-3354
Practice Address - Country:US
Practice Address - Phone:620-688-6595
Practice Address - Fax:888-975-3464
Is Sole Proprietor?:No
Enumeration Date:2011-12-08
Last Update Date:2021-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK5538101YM0800X
KS2934101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS201122950AMedicaid
OK200402920BMedicaid
OK200575340AMedicaid