Healthcare Provider Details

I. General information

NPI: 1720857675
Provider Name (Legal Business Name): CASSANDRA JACKSON LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/20/2023
Last Update Date: 07/13/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

434 EASTLAND RD
BEREA OH
44017-1217
US

IV. Provider business mailing address

2551 TABERVILLE DR
BLACKLICK OH
43004-3521
US

V. Phone/Fax

Practice location:
  • Phone: 440-234-2006
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberM.2600428
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: