Provider Demographics
NPI:1841689312
Name:SEAVEY, JACQUELINE (MA, AT, LPCC)
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:
Last Name:SEAVEY
Suffix:
Gender:F
Credentials:MA, AT, LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3275 MIDLAND AVE
Mailing Address - Street 2:
Mailing Address - City:WHITE BEAR LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:55110-5321
Mailing Address - Country:US
Mailing Address - Phone:651-276-0374
Mailing Address - Fax:
Practice Address - Street 1:357 KELLOGG BLVD E
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55101-1411
Practice Address - Country:US
Practice Address - Phone:612-578-2167
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-21
Last Update Date:2018-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health