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General NPI Number Information
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NPI Number | 1356505366
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Entity Type | Individual
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Provider Name | JACQUELINE A NUVAL PHD
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Gender | Female
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Dates
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Enumeration Date | 07/18/2008
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Last Update Date | 02/23/2023
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Provider Practice Location Address
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Address Line | 4400 EASTON CMNS STE 125
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City | COLUMBUS
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State | OH
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Zip | 43219-6223
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Country | US
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Telephone | 574-546-1900
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Fax | 574-546-1999
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Provider Business Mailing Address
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Address Line | PO BOX 10299
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City | FORT WAYNE
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State | IN
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Zip | 46851-0299
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Country | US
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Telephone | 574-546-1900
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Fax | 574-546-1999
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 39024
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 39000625A
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License Number State | IN
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Taxonomy #3
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | P.08436
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License Number State | OH
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Taxonomy #4
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 20042692A
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License Number State | IN
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