Provider Demographics
NPI:1548009731
Name:SHACKLEFORD, JAEL (LPC ASSOCIATE)
Entity type:Individual
Prefix:MRS
First Name:JAEL
Middle Name:
Last Name:SHACKLEFORD
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 1:1400 STEVE DR
Mailing Address - Street 2:
Mailing Address - City:CROWLEY
Mailing Address - State:TX
Mailing Address - Zip Code:76036-1382
Mailing Address - Country:US
Mailing Address - Phone:678-431-1327
Mailing Address - Fax:
Practice Address - Street 1:7550 FM 1187 W
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76126-5109
Practice Address - Country:US
Practice Address - Phone:888-744-2779
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-20
Last Update Date:2024-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX87771101YM0800X, 101YS0200X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool