Provider Demographics
NPI:1154569564
Name:JACKSON, LYNSEY M (BCABA)
Entity type:Individual
Prefix:
First Name:LYNSEY
Middle Name:M
Last Name:JACKSON
Suffix:
Gender:F
Credentials:BCABA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14110 CYPRESS CREEK BLVD
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:TX
Mailing Address - Zip Code:77429-3214
Mailing Address - Country:US
Mailing Address - Phone:281-894-1423
Mailing Address - Fax:281-894-1423
Practice Address - Street 1:14110 CYPRESS CREEK BLVD
Practice Address - Street 2:
Practice Address - City:CYPRESS
Practice Address - State:TX
Practice Address - Zip Code:77429-3214
Practice Address - Country:US
Practice Address - Phone:281-894-1423
Practice Address - Fax:281-894-1423
Is Sole Proprietor?:No
Enumeration Date:2009-01-23
Last Update Date:2009-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX008-2660103K00000X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No174400000XOther Service ProvidersSpecialist