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NPI Code Detail

MEDICARE: MS. CHRIS JACKSON MFT

MEDICARE: MS. CHRIS JACKSON MFT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health CounselorMFC 39686CA

General Provider Information

NPI Number : 1316011190
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. CHRIS JACKSON MFT
Provider Business Mailing Address
First Line : PO BOX 6622
Second Line :
City : CHICO
State : CA
Zip : 95927-6622
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 22425 SUNBRIGHT AVE
Second Line :
City : RED BLUFF
State : CA
Zip : 96080-9741
Country : US
Telephone Number : 530-528-2342
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/20/2006
Last Update Date : 02/28/2023

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