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General NPI Number Information
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NPI Number | 1760733398
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Entity Type | Individual
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Provider Name | JACQUELINE KATHLEEN CLARKE JEMMOTT PHD
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Gender | Female
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Dates
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Enumeration Date | 09/22/2012
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Last Update Date | 08/28/2018
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Provider Practice Location Address
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Address Line | 7203 PINE FOREST RD
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City | PENSACOLA
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State | FL
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Zip | 32526
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Country | US
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Telephone | 954-274-0507
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 835
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City | CANTONMENT
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State | FL
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Zip | 32533-0835
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Country | US
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Telephone | 954-274-0507
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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 | MCAP010627
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License Number State | FL
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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 | MT2821
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | MT2821
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License Number State | FL
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