Healthcare Provider Details

I. General information

NPI: 1831535095
Provider Name (Legal Business Name): JACLYN SUTTON RANGEL LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2013
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3600 SAN JERONIMO DR
ANCHORAGE AK
99508-2870
US

IV. Provider business mailing address

3600 SAN JERONIMO DR
ANCHORAGE AK
99508-2870
US

V. Phone/Fax

Practice location:
  • Phone: 907-793-3600
  • Fax:
Mailing address:
  • Phone: 907-793-3600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberCP5798
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number253423
License Number StateAK
# 3
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberCP5798
License Number StateNV
# 4
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number234271
License Number StateAK
# 5
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberCP5798
License Number StateNV
# 6
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number00687-C
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: