| Doctor Name: | KATODRA JACKSON |
| NPI Number: | 1184844763 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | M.S., LPC, NCC |
| License Number: | 61137 |
| Business Practice Address: | 100 W Central Texas Expy Ste. 208 Harker Heights, TX - 765482079 |
| Business Phone Number: | 2542894322 |
| Business Fax Number: | 2546345222 |
| Mailing Address: | 100 W Central Texas Expy, Ste. 208 HARKER HEIGHTS |
| State: | TX |
| Postal Code: | 765482080 |
| Phone Number: | 2542894322 |
| Fax Number: | 2546345222 |
| NPI Enumeration Date: | 04/26/2007 |
| NPI Last Update Date: | 07/25/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YP2500X |
| License Number: | 61137 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | TX |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Professional |
| Taxonomy Definition: | |