MEDICARE: MEGHAN T JACKSON LPC

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	101YP2500X	Professional Counselor	003175	CT

General Provider Information

NPI Number	:	1558870774
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MEGHAN T JACKSON LPC

Provider Business Mailing Address
First Line	:	1100 NEW BRITAIN AVE STE 201
Second Line	:
City	:	WEST HARTFORD
State	:	CT
Zip	:	06110-2447
Country	:	US
Telephone Number	:	860-970-8639
Fax Number	:	860-970-8639

Provider Business Practice Location Address
First Line	:	1100 NEW BRITAIN AVE STE 201
Second Line	:
City	:	WEST HARTFORD
State	:	CT
Zip	:	06110-2447
Country	:	US
Telephone Number	:	860-970-8639
Fax Number	:	860-970-8639

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

Provider Enumeration Date	:	09/20/2017
Last Update Date	:	07/21/2022

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