| Doctor Name: | TERRY LEWIS JACKSON |
| NPI Number: | 1811067606 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | LCPC |
| License Number: | |
| Business Practice Address: | 17 W Water St Pinckneyville, IL - 622741027 |
| Business Phone Number: | 6183573396 |
| Business Fax Number: | 6183573396 |
| Mailing Address: | 17 W Water St, PINCKNEYVILLE |
| State: | IL |
| Postal Code: | 622741027 |
| Phone Number: | 6183573396 |
| Fax Number: | 6183573396 |
| NPI Enumeration Date: | 11/08/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YP2500X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | IL |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Professional |
| Taxonomy Definition: | |