| Doctor Name: | ILLYA JACKSON |
| NPI Number: | 1700269149 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | |
| License Number: | IACCP0064 |
| Business Practice Address: | 1518 Vaughn Blvd Ft Worth, TX - 761052307 |
| Business Phone Number: | 2145152079 |
| Business Fax Number: | |
| Mailing Address: | 1518 Vaughn Blvd, FT WORTH |
| State: | TX |
| Postal Code: | 761052307 |
| Phone Number: | 2145152079 |
| Fax Number: | |
| NPI Enumeration Date: | 07/02/2015 |
| NPI Last Update Date: | 07/02/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 106H00000X |
| License Number: | IACCP0064 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CA |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Marriage & Family Therapist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A marriage and family therapist is a person with a master's degree in marriage and family therapy, or a master's or doctoral degree in a related mental health field with substantially equivalent coursework in marriage and family therapy, who receives supervised clinical experience, or a person who meets the state requirements to practice as a marriage and family therapist. A marriage and family therapist treats mental and emotional disorders within the context of marriage and family systems. A marriage and family therapist provides mental health and counseling services to individuals, couples, families, and groups. |