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General NPI Number Information
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NPI Number | 1477323558
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Entity Type | Individual
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Provider Name | JACQUELINE NWEVO M.ED
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Gender | Female
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Dates
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Enumeration Date | 01/08/2024
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Last Update Date | 01/08/2024
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Provider Practice Location Address
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Address Line | 3685 SAINT ANDREWS DR
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City | BEAUMONT
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State | TX
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Zip | 77707-5480
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Country | US
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Telephone | 409-812-6125
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Fax |
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Provider Business Mailing Address
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Address Line | 3685 SAINT ANDREWS DR
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City | BEAUMONT
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State | TX
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Zip | 77707-5480
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Country | US
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Telephone | 409-812-6125
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 84002
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License Number State | TX
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