| Doctor Name: | HELEN JACKSON |
| NPI Number: | 1548616121 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | MASTER |
| License Number: | |
| Business Practice Address: | 1700 Lake St Lake Providence, LA - 712545208 |
| Business Phone Number: | 3185590551 |
| Business Fax Number: | 3155590532 |
| Mailing Address: | 1700 Lake St, LAKE PROVIDENCE |
| State: | LA |
| Postal Code: | 712545208 |
| Phone Number: | 3185590551 |
| Fax Number: | 3185590538 |
| NPI Enumeration Date: | 05/12/2016 |
| NPI Last Update Date: | 05/12/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |