Courtney D Jaeckle, MA, LPC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

78798 Issued in TX

Practice address

6373 County Road 2520
Royse City, TX 75189-8017

Phone

(323) 639-8463

NPI assigned

Sep 23, 2020

Last updated

Jun 20, 2023By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Arts

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Divine Path Ranch

  • Mental Health Counselor
  • Royse City, TX
  • NPI 1265117030
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1600819200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1687219200000",
    "number": "1134736234",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 155",
            "city": "ROYSE CITY",
            "state": "TX",
            "postal_code": "751890155",
            "telephone_number": "214-415-5123"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6373 COUNTY ROAD 2520",
            "city": "ROYSE CITY",
            "state": "TX",
            "postal_code": "751898017",
            "telephone_number": "323-639-8463"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "8617 Fairfax Ave",
            "address_purpose": "LOCATION",
            "city": "Rowlett",
            "state": "TX",
            "postal_code": "750892420",
            "country_code": "US",
            "telephone_number": "214-415-5123",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JAECKLE",
        "first_name": "COURTNEY",
        "middle_name": "D",
        "credential": "MA, LPC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-09-23",
        "last_updated": "2023-06-20",
        "certification_date": "2023-06-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "TX",
            "license": "78798",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "cjaeckle@newvinecounseling.com",
            "affiliation": "N",
            "endpointDescription": "email",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "8617 Fairfax Ave",
            "city": "Rowlett",
            "state": "TX",
            "country_code": "US",
            "postal_code": "750892420",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Mental Health Counselor in Royse City, TX
• Providers in Royse City, TX by specialty
• Mental Health Counselor in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 20, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.