Healthcare Provider Details

I. General information

NPI: 1568397263
Provider Name (Legal Business Name): LUKE PERRY JACKSON
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/15/2026
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

932 E BELMONT ST
PENSACOLA FL
32501-4914
US

IV. Provider business mailing address

932 E BELMONT ST
PENSACOLA FL
32501-4914
US

V. Phone/Fax

Practice location:
  • Phone: 850-776-2515
  • Fax:
Mailing address:
  • Phone: 850-776-2515
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH27874
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: