MEDICARE: ELEANOR WILLIAMSON JACKSON LPCC

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
1	101YM0800X	Mental Health Counselor	LPCC.0022921	CO

General Provider Information

NPI Number	:	1538039045
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELEANOR WILLIAMSON JACKSON LPCC

Provider Business Mailing Address
First Line	:	1750 LITTLE RAVEN ST APT 222
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80202-7148
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2839 WYANDOT ST
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80211-4315
Country	:	US
Telephone Number	:	720-340-3792
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/10/2025
Last Update Date	:	11/10/2025

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