Provider Demographics
NPI:1144078031
Name:MOSSAKOWSKI, JACQUELINE THERESE (LPC-ASSOCIATE)
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:THERESE
Last Name:MOSSAKOWSKI
Suffix:
Gender:F
Credentials:LPC-ASSOCIATE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1429 PERCHERON RD
Mailing Address - Street 2:
Mailing Address - City:AUBREY
Mailing Address - State:TX
Mailing Address - Zip Code:76227-2068
Mailing Address - Country:US
Mailing Address - Phone:972-832-1383
Mailing Address - Fax:
Practice Address - Street 1:1429 PERCHERON RD
Practice Address - Street 2:
Practice Address - City:AUBREY
Practice Address - State:TX
Practice Address - Zip Code:76227-2068
Practice Address - Country:US
Practice Address - Phone:972-832-1383
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-07
Last Update Date:2024-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX94544101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional