Jaclyn W Smith, MA LPC-S

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

68019 Issued in TX

Practice address

5351 Samuell Blvd
Dallas, TX 75228-6720

Phone

(214) 818-2600

Fax

(214) 818-2645

NPI assigned

Jan 28, 2014

Last updated

Sep 27, 2017By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Jaclyn M Watkins Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

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.

• Dallas Children's Advocacy Center

  • Professional Counselor
  • Dallas, TX
  • NPI 1083035471
  NPD (past)
• Dallas Children's Advocacy Center

  • Community/Behavioral Health Agency
  • Dallas, TX
  • NPI 1609248228
  NPD (past)

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

{
    "created_epoch": "1390867200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1506470400000",
    "number": "1700209681",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4725 LAKE COVE WAY",
            "city": "FRISCO",
            "state": "TX",
            "postal_code": "75034",
            "telephone_number": "210-771-3034"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5351 SAMUELL BLVD",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752286720",
            "telephone_number": "214-818-2600",
            "fax_number": "214-818-2645"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SMITH",
        "first_name": "JACLYN",
        "middle_name": "W",
        "credential": "MA LPC-S",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-01-28",
        "last_updated": "2017-09-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "TX",
            "license": "68019",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JACLYN",
            "last_name": "WATKINS",
            "middle_name": "M",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Herbert J. Smith, M.D.
• Howard Brian Smith, MD
• Ian Joseph Smith, L.P.C.
• Ilia Jamila Smith, APRN, CNM, WHNP-BC
• Irma Estela Smith, MS CCC SLP
• Jacqueline D. Smith, RN, MS, FNP-C
• James William Smith, M.D.
• Jamicwa Smith
• Jamie Smith, BSN, RN, CA-SANE
• Jamie Marie Smith, PSYCHOLOGIST

• Professional Counselor in Dallas, TX
• Providers in Dallas, TX by specialty
• Professional Counselor in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 27, 2017; 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.