Active NPI
Bridget Jaecks, MS, LPC, LCDC
- Professional Counselor
- Lake Dallas, TX
National Provider Identifier
1144642307
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 64622
- Practice address
- 2002 S Stemmons Fwy
Suite 230
Lake Dallas, TX 75065-3632 - Phone
- (903) 714-7069
- NPI assigned
- Jan 7, 2014
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | 9504 | TX | |
| Professional Counselor | 101YP2500X | 64622 | TX | Primary |
Addresses
Primary practice location
2002 S Stemmons Fwy
Suite 230
Lake Dallas, TX 75065-3632
Mailing address
2002 S Stemmons Fwy
Suite 230
Lake Dallas, TX 75065-3632
Phone (903) 714-7069
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 64622 | TX | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1389052800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1389052800000",
"number": "1144642307",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2002 S STEMMONS FWY",
"address_2": "SUITE 230",
"city": "LAKE DALLAS",
"state": "TX",
"postal_code": "750653632",
"telephone_number": "903-714-7069"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2002 S STEMMONS FWY",
"address_2": "SUITE 230",
"city": "LAKE DALLAS",
"state": "TX",
"postal_code": "750653632",
"telephone_number": "903-714-7069"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JAECKS",
"first_name": "BRIDGET",
"name_prefix": "Mrs.",
"credential": "MS, LPC, LCDC",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2014-01-07",
"last_updated": "2014-01-07",
"status": "A"
},
"taxonomies": [
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": "TX",
"license": "9504",
"primary": false
},
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "TX",
"license": "64622",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lake Dallas, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 7, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.