Healthcare Provider Details

I. General information

NPI: 1104307180
Provider Name (Legal Business Name): JACLYN HARVEL LMHC, LCPC, CCTP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/27/2018
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2656 SUNRAY VENUS WAY
RUSKIN FL
33570-5031
US

IV. Provider business mailing address

2656 SUNRAY VENUS WAY
RUSKIN FL
33570-5031
US

V. Phone/Fax

Practice location:
  • Phone: 847-528-2710
  • Fax:
Mailing address:
  • Phone: 847-528-2710
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number180.015617
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberMH24095
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH24095
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: