Healthcare Provider Details

I. General information

NPI: 1831590884
Provider Name (Legal Business Name): JACKSON J SPENCER M.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2014
Last Update Date: 02/10/2026
Certification Date: 02/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5740 N PALM AVE STE 101
FRESNO CA
93704-1800
US

IV. Provider business mailing address

5740 N PALM AVE STE 101
FRESNO CA
93704-1800
US

V. Phone/Fax

Practice location:
  • Phone: 559-547-0907
  • Fax: 559-705-1921
Mailing address:
  • Phone: 559-547-0907
  • Fax: 559-705-1921

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number81152
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number110577
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number110577
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: