Healthcare Provider Details

I. General information

NPI: 1063950749
Provider Name (Legal Business Name): JACKSON CONSULTING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/02/2017
Last Update Date: 02/03/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8031 WEST CENTER ROAD #207
OMAHA NE
68124
US

IV. Provider business mailing address

8031 WEST CENTER ROAD #207
OMAHA NE
68124
US

V. Phone/Fax

Practice location:
  • Phone: 402-415-4150
  • Fax: 402-377-7111
Mailing address:
  • Phone: 402-415-4150
  • Fax: 402-377-7111

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNE
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: TARA M JACKSON-SANDERS
Title or Position: DIRECTOR
Credential: DIRECTOR OF OPERATIO
Phone: 402-321-9225