Provider Demographics
NPI:1871903401
Name:TODD, JACKIE (NCC, LPC, CEAP)
Entity type:Individual
Prefix:
First Name:JACKIE
Middle Name:
Last Name:TODD
Suffix:
Gender:F
Credentials:NCC, LPC, CEAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7271 CABOT ESTATES DR
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063-4654
Mailing Address - Country:US
Mailing Address - Phone:214-799-1021
Mailing Address - Fax:
Practice Address - Street 1:3939 W GREEN OAKS BLVD
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76016-2784
Practice Address - Country:US
Practice Address - Phone:214-799-1021
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-05
Last Update Date:2021-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX69842101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health