Provider Demographics
NPI:1194596676
Name:JACKSON THERAPY & CONSULTING LLC
Entity type:Organization
Organization Name:JACKSON THERAPY & CONSULTING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LIMHP
Authorized Official - Prefix:MS
Authorized Official - First Name:RONELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:308-529-3551
Mailing Address - Street 1:4719 27TH ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:NE
Mailing Address - Zip Code:68601-2157
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4719 27TH ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:NE
Practice Address - Zip Code:68601-2157
Practice Address - Country:US
Practice Address - Phone:308-529-3551
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-12
Last Update Date:2024-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty