Healthcare Provider Details

I. General information

NPI: 1619163599
Provider Name (Legal Business Name): KARRIN LYNISE JACKSON LMP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/24/2007
Last Update Date: 06/27/2025
Certification Date: 06/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3075 CITRUS CIR STE 165
WALNUT CREEK CA
94598-2669
US

IV. Provider business mailing address

3075 CITRUS CIR STE 165
WALNUT CREEK CA
94598-2669
US

V. Phone/Fax

Practice location:
  • Phone: 259-553-3376
  • Fax:
Mailing address:
  • Phone: 925-553-3376
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA00017797
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: