Healthcare Provider Details

I. General information

NPI: 1134459290
Provider Name (Legal Business Name): JACQUELINE ALEXIS HATTEN LPCC-S
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/12/2010
Last Update Date: 02/25/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

453 ALLENBY DR
MARYSVILLE OH
43040-8722
US

IV. Provider business mailing address

8316 BRUNTSFIELD RD
COLUMBUS OH
43235-8425
US

V. Phone/Fax

Practice location:
  • Phone: 937-642-0048
  • Fax: 937-642-1316
Mailing address:
  • Phone: 614-657-5225
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberE.0007661-SUPR
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: