MEDICARE: JUDY GAIL WHITE-JACKSON MA, 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	9899	LA
2	101YP2500X	Professional Counselor	76030	TX

General Provider Information

NPI Number	:	1902388333
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JUDY GAIL WHITE-JACKSON MA, LPC

Provider Business Mailing Address
First Line	:	505 N SAM HOUSTON PKWY E STE 303
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77060-4086
Country	:	US
Telephone Number	:	281-687-7053
Fax Number	:	832-617-8347

Provider Business Practice Location Address
First Line	:	505 N SAM HOUSTON PKWY E STE 303
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77060-4086
Country	:	US
Telephone Number	:	281-687-7053
Fax Number	:	832-617-8347

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

Provider Enumeration Date	:	09/01/2018
Last Update Date	:	06/24/2025

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