Healthcare Provider Details

I. General information

NPI: 1154267698
Provider Name (Legal Business Name): JACLYN ROSE MCCORD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/27/2026
Last Update Date: 04/27/2026
Certification Date: 04/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 CHURCH ST
HALF MOON BAY CA
94019-1904
US

IV. Provider business mailing address

596 AVENUE ALHAMBRA
EL GRANADA CA
94018-8133
US

V. Phone/Fax

Practice location:
  • Phone: 650-439-3312
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: