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General NPI Number Information
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NPI Number | 1144642307
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Entity Type | Individual
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Provider Name | BRIDGET JAECKS MS, LPC, LCDC
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Gender | Female
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Dates
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Enumeration Date | 01/07/2014
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Last Update Date | 01/07/2014
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Provider Practice Location Address
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Address Line | 2002 S STEMMONS FWY SUITE 230
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City | LAKE DALLAS
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State | TX
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Zip | 75065-3632
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Country | US
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Telephone | 903-714-7069
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Fax |
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Provider Business Mailing Address
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Address Line | 2002 S STEMMONS FWY SUITE 230
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City | LAKE DALLAS
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State | TX
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Zip | 75065-3632
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Country | US
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Telephone | 903-714-7069
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 9504
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 64622
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License Number State | TX
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