Provider Demographics
NPI:1932565926
Name:RECKAS, JACKIE
Entity Type:Individual
Prefix:MS
First Name:JACKIE
Middle Name:
Last Name:RECKAS
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:S.
Other - Middle Name:JACKIE
Other - Last Name:RECKAS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA
Mailing Address - Street 1:1811 SANTA RITA RD
Mailing Address - Street 2:#226
Mailing Address - City:PLEASANTON
Mailing Address - State:CA
Mailing Address - Zip Code:94566-4746
Mailing Address - Country:US
Mailing Address - Phone:925-216-3433
Mailing Address - Fax:925-846-0581
Practice Address - Street 1:1811 SANTA RITA RD
Practice Address - Street 2:#226
Practice Address - City:PLEASANTON
Practice Address - State:CA
Practice Address - Zip Code:94566-4746
Practice Address - Country:US
Practice Address - Phone:925-426-9182
Practice Address - Fax:925-846-0581
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-07
Last Update Date:2020-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC33679106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist