Provider Demographics
NPI:1114738499
Name:JACKSON HEALING
Entity type:Organization
Organization Name:JACKSON HEALING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MASTER CLINICICAN
Authorized Official - Prefix:
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:GOOLSBY
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LPC, NCC, CPT-C
Authorized Official - Phone:517-581-4710
Mailing Address - Street 1:2020 CASCADE DR
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49203-3810
Mailing Address - Country:US
Mailing Address - Phone:517-581-4710
Mailing Address - Fax:517-905-5906
Practice Address - Street 1:720 W FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49201-1674
Practice Address - Country:US
Practice Address - Phone:734-726-4038
Practice Address - Fax:517-905-5906
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-16
Last Update Date:2025-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No251S00000XAgenciesCommunity/Behavioral Health
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health