| Doctor Name: | IREE JACKSON |
| NPI Number: | 1275991176 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | LAC |
| License Number: | 823 |
| Business Practice Address: | 404 E Craig St Tallulah, LA - 712823718 |
| Business Phone Number: | 3185744164 |
| Business Fax Number: | 3185744164 |
| Mailing Address: | 815 W Craig Street, TALLULAH |
| State: | LA |
| Postal Code: | 71282 |
| Phone Number: | 3185744776 |
| Fax Number: | 3185744164 |
| NPI Enumeration Date: | 02/05/2016 |
| NPI Last Update Date: | 02/05/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YA0400X |
| License Number: | 823 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | LA |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Addiction (Substance Use Disorder) |
| Taxonomy Definition: | |