| Doctor Name: | MRS. STEPHANIE JACKSON |
| NPI Number: | 1417070921 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | MA, LSSP, LPC |
| License Number: | 20255 |
| Business Practice Address: | 1402 N Oak St Box 1272 Pearsall, TX - 780613417 |
| Business Phone Number: | 7133037292 |
| Business Fax Number: | 8303343989 |
| Mailing Address: | Po Box 1272, PEARSALL |
| State: | TX |
| Postal Code: | 780611272 |
| Phone Number: | 7133037292 |
| Fax Number: | 8303343989 |
| NPI Enumeration Date: | 04/09/2007 |
| NPI Last Update Date: | 04/19/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YP2500X |
| License Number: | 20255 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | TX |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Professional |
| Taxonomy Definition: | |