Provider Demographics
NPI:1922615004
Name:KIMMEL, JACLYN R (LPC)
Entity type:Individual
Prefix:
First Name:JACLYN
Middle Name:R
Last Name:KIMMEL
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2633 E INDIAN SCHOOL RD STE 250
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85016-0703
Mailing Address - Country:US
Mailing Address - Phone:602-831-2131
Mailing Address - Fax:480-522-1121
Practice Address - Street 1:2633 E INDIAN SCHOOL RD STE 250
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016-0703
Practice Address - Country:US
Practice Address - Phone:602-831-2131
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-23
Last Update Date:2025-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC-17563101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional