Doctor Name: | LARA ELIZABETH JACKSON |
NPI Number: | 1467884015 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | |
License Number: | |
Business Practice Address: | 5750 Sunrise Blvd Citrus Heights, CA - 956107634 |
Business Phone Number: | 9163440249 |
Business Fax Number: | |
Mailing Address: | 8352 Willowdale Way, FAIR OAKS |
State: | CA |
Postal Code: | 956285211 |
Phone Number: | 9165390622 |
Fax Number: | |
NPI Enumeration Date: | 08/06/2013 |
NPI Last Update Date: | 08/20/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101Y00000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | N |
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 |