Healthcare Provider Details

I. General information

NPI: 1598796377
Provider Name (Legal Business Name): PATRICIA K. JACKLEY PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4500 S LANCASTER RD
DALLAS TX
75216-7167
US

IV. Provider business mailing address

2013 KIDWELL ST
DALLAS TX
75214-3965
US

V. Phone/Fax

Practice location:
  • Phone: 214-857-0799
  • Fax: 214-857-0902
Mailing address:
  • Phone: 214-857-0799
  • Fax: 214-857-0902

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TA0400X
TaxonomyAddiction (Substance Use Disorder) Psychologist
License Number31748
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number31748
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: