Doctor Name: | ANGELA M JACKSON |
NPI Number: | 1255352969 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LPC |
License Number: | 3591406004 |
Business Practice Address: | 5030 Harrison Blvd Ogden, UT - 844034311 |
Business Phone Number: | 8014421654 |
Business Fax Number: | |
Mailing Address: | Po Box 27128, SALT LAKE CITY |
State: | UT |
Postal Code: | 841270128 |
Phone Number: | 8013875620 |
Fax Number: | |
NPI Enumeration Date: | 07/21/2006 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101Y00000X |
License Number: | 3591406004 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | UT |
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 |