Provider Demographics
NPI:1831535095
Name:SUTTON RANGEL, JACLYN (LPC)
Entity type:Individual
Prefix:
First Name:JACLYN
Middle Name:
Last Name:SUTTON RANGEL
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3600 SAN JERONIMO DR
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-2870
Mailing Address - Country:US
Mailing Address - Phone:907-793-3600
Mailing Address - Fax:
Practice Address - Street 1:3149 MOUNTAIN VIEW DR
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99501-3106
Practice Address - Country:US
Practice Address - Phone:907-793-3600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-15
Last Update Date:2025-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVCP5798101Y00000X, 101YM0800X, 101YP2500X
NV00687-C101YA0400X
AK234271101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health