| Doctor Name: | MICHAEL SCOTT JACKSON |
| NPI Number: | 1962647107 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | |
| License Number: | |
| Business Practice Address: | 16940 Highway 14 Suite F Mojave, CA - 935011238 |
| Business Phone Number: | 6618245020 |
| Business Fax Number: | 6618245026 |
| Mailing Address: | 16940 Highway 14, Suite F MOJAVE |
| State: | CA |
| Postal Code: | 935011238 |
| Phone Number: | 6618245020 |
| Fax Number: | 6618245026 |
| NPI Enumeration Date: | 12/02/2008 |
| NPI Last Update Date: | 12/02/2008 |
| 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: | |