Provider Demographics
NPI:1306596143
Name:JACKSON, DEBORAH BELINDA (LMSW)
Entity type:Individual
Prefix:MS
First Name:DEBORAH
Middle Name:BELINDA
Last Name:JACKSON
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1221 MARSHALL DR
Mailing Address - Street 2:
Mailing Address - City:JUNCTION CITY
Mailing Address - State:KS
Mailing Address - Zip Code:66441-4524
Mailing Address - Country:US
Mailing Address - Phone:785-375-1545
Mailing Address - Fax:
Practice Address - Street 1:1221 MARSHALL DR
Practice Address - Street 2:
Practice Address - City:JUNCTION CITY
Practice Address - State:KS
Practice Address - Zip Code:66441-4524
Practice Address - Country:US
Practice Address - Phone:785-375-1545
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-25
Last Update Date:2022-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSLMSW9127101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health