Provider Demographics
NPI:1144642307
Name:JAECKS, BRIDGET (MS, LPC, LCDC)
Entity type:Individual
Prefix:MRS
First Name:BRIDGET
Middle Name:
Last Name:JAECKS
Suffix:
Gender:F
Credentials:MS, LPC, LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2002 S STEMMONS FWY
Mailing Address - Street 2:SUITE 230
Mailing Address - City:LAKE DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75065-3632
Mailing Address - Country:US
Mailing Address - Phone:903-714-7069
Mailing Address - Fax:
Practice Address - Street 1:2002 S STEMMONS FWY
Practice Address - Street 2:SUITE 230
Practice Address - City:LAKE DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75065-3632
Practice Address - Country:US
Practice Address - Phone:903-714-7069
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-07
Last Update Date:2014-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9504101YA0400X
TX64622101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)