Provider Demographics
NPI:1780888669
Name:HALSTEAD, JACKIE LYNN (PHD)
Entity type:Individual
Prefix:DR
First Name:JACKIE
Middle Name:LYNN
Last Name:HALSTEAD
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 PINE ST
Mailing Address - Street 2:SUITE 610
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79601-5945
Mailing Address - Country:US
Mailing Address - Phone:325-669-9760
Mailing Address - Fax:
Practice Address - Street 1:104 PINE ST
Practice Address - Street 2:SUITE 610
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79601-5945
Practice Address - Country:US
Practice Address - Phone:325-669-9760
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX4835106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist