Provider Demographics
NPI:1063950749
Name:JACKSON CONSULTING LLC
Entity type:Organization
Organization Name:JACKSON CONSULTING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TARA
Authorized Official - Middle Name:M
Authorized Official - Last Name:JACKSON-SANDERS
Authorized Official - Suffix:
Authorized Official - Credentials:DIRECTOR OF OPERATIO
Authorized Official - Phone:402-321-9225
Mailing Address - Street 1:8031 WEST CENTER ROAD
Mailing Address - Street 2:#207
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68124
Mailing Address - Country:US
Mailing Address - Phone:402-415-4150
Mailing Address - Fax:402-377-7111
Practice Address - Street 1:8031 WEST CENTER ROAD
Practice Address - Street 2:#207
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68124
Practice Address - Country:US
Practice Address - Phone:402-415-4150
Practice Address - Fax:402-377-7111
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-02
Last Update Date:2017-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YP2500X
NE101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty