Provider Demographics
NPI:1710541644
Name:CAIRNS, JACLYN MARIE
Entity type:Individual
Prefix:MRS
First Name:JACLYN
Middle Name:MARIE
Last Name:CAIRNS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2651
Mailing Address - Street 2:
Mailing Address - City:PALM SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:92263-2651
Mailing Address - Country:US
Mailing Address - Phone:760-288-4579
Mailing Address - Fax:760-288-3752
Practice Address - Street 1:19-531 MCLANE STREET
Practice Address - Street 2:SUITE B
Practice Address - City:PALM SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92263-3459
Practice Address - Country:US
Practice Address - Phone:760-288-4579
Practice Address - Fax:760-288-3752
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-25
Last Update Date:2023-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13914101YM0800X
CA8789101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health