Active NPI
Jacqueline Daves, LPA, LCDC
- Professional Counselor
- Kilgore, TX
National Provider Identifier
1871740027
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 14856
- Practice address
- 400 E Main St
Kilgore, TX 75662-5906 - Phone
- (903) 984-2787
- Fax
- (903) 984-0517
- NPI assigned
- Aug 19, 2008
- Last updated
- Aug 19, 2008
- 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 | 2586 | TX | |
| Professional Counselor | 101YP2500X | 14856 | TX | Primary |
Addresses
Primary practice location
400 E Main St
Kilgore, TX 75662-5906
Mailing address
400 E Main St
Kilgore, TX 75662-5906
Phone (903) 984-2787
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2586 | TX | MD | Addiction (Substance Use Disorder) Counselor |
| 14856 | TX | MD | Psychiatric Hospital |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Grant-Moore Center for Behavioral Health, Inc. | Professional | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Professional Counselor
- Kilgore, TX
- NPI 1134206519
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1219104000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1219104000000",
"number": "1871740027",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "400 E MAIN ST",
"city": "KILGORE",
"state": "TX",
"postal_code": "756625906",
"telephone_number": "903-984-2787",
"fax_number": "903-984-0517"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "400 E MAIN ST",
"city": "KILGORE",
"state": "TX",
"postal_code": "756625906",
"telephone_number": "903-984-2787",
"fax_number": "903-984-0517"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DAVES",
"first_name": "JACQUELINE",
"name_prefix": "Ms.",
"credential": "LPA, LCDC",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2008-08-19",
"last_updated": "2008-08-19",
"status": "A"
},
"taxonomies": [
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": "TX",
"license": "2586",
"primary": false
},
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "TX",
"license": "14856",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Kilgore, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 19, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.