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General NPI Number Information
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NPI Number | 1295606275
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Entity Type | Individual
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Provider Name | JACLYN HARTL M.ED, LPC - S
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Gender | Female
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Dates
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Enumeration Date | 09/15/2025
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Last Update Date | 09/15/2025
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Provider Practice Location Address
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Address Line | 5415 STATE HIGHWAY 35 S
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City | PORT LAVACA
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State | TX
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Zip | 77979-5730
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Country | US
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Telephone | 361-648-2026
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Fax |
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Provider Business Mailing Address
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Address Line | 5415 STATE HIGHWAY 35 S
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City | PORT LAVACA
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State | TX
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Zip | 77979-5730
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Country | US
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Telephone | 361-648-2026
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 80869
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License Number State | TX
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