Doctor Name: | MR. RICHARD JACKSON |
NPI Number: | 1376730291 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | LPC |
License Number: | NCC57750 |
Business Practice Address: | 156 N Bellevue Blvd Memphis, TN - 381047201 |
Business Phone Number: | 9017285554 |
Business Fax Number: | 9017285554 |
Mailing Address: | Po Box 41722, MEMPHIS |
State: | TN |
Postal Code: | 381741722 |
Phone Number: | 9017285554 |
Fax Number: | 9017286011 |
NPI Enumeration Date: | 09/25/2007 |
NPI Last Update Date: | 09/25/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101Y00000X |
License Number: | NCC57750 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | TN |
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 |