Doctor Name: | MILDRED JACKSON |
NPI Number: | 1194195404 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | |
License Number: | |
Business Practice Address: | 300 Foxglove Dr Mt Sterling, KY - 403539769 |
Business Phone Number: | 8594982135 |
Business Fax Number: | |
Mailing Address: | 300 Foxglove Dr, MT STERLING |
State: | KY |
Postal Code: | 403539769 |
Phone Number: | 8594982135 |
Fax Number: | |
NPI Enumeration Date: | 09/29/2015 |
NPI Last Update Date: | 09/29/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101Y00000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | |
Taxonomy Definition: | A provider who is trained and educated in the performance of behavior health services through interpersonal communications and analysis. Training and education at the specialty level usually requires a master |