Provider Demographics
NPI:1417779570
Name:JACKSON, SCOTT (LPC)
Entity type:Individual
Prefix:MR
First Name:SCOTT
Middle Name:
Last Name:JACKSON
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13401 MISSION RD STE 216
Mailing Address - Street 2:
Mailing Address - City:LEAWOOD
Mailing Address - State:KS
Mailing Address - Zip Code:66209-3313
Mailing Address - Country:US
Mailing Address - Phone:913-340-4494
Mailing Address - Fax:
Practice Address - Street 1:13401 MISSION RD STE 216
Practice Address - Street 2:
Practice Address - City:LEAWOOD
Practice Address - State:KS
Practice Address - Zip Code:66209-3313
Practice Address - Country:US
Practice Address - Phone:913-340-4494
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-29
Last Update Date:2024-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04868101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health