MEDICARE: JACLYN POE BAILES LPC-ASSOCIATE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	90524	TX

General Provider Information

NPI Number	:	1326750761
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACLYN POE BAILES LPC-ASSOCIATE

Provider Business Mailing Address
First Line	:	202 PRIVATE ROAD 1280
Second Line	:
City	:	FAIRFIELD
State	:	TX
Zip	:	75840-5188
Country	:	US
Telephone Number	:	903-948-8038
Fax Number	:

Provider Business Practice Location Address
First Line	:	510 AUSTIN AVE
Second Line	:
City	:	WACO
State	:	TX
Zip	:	76701-2107
Country	:	US
Telephone Number	:	903-948-8038
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/16/2022
Last Update Date	:	12/16/2022

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Directions to “ JACLYN POE BAILES LPC-ASSOCIATE” Practice Location

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