Healthcare Provider Details

I. General information

NPI: 1730005836
Provider Name (Legal Business Name): JACKSON SERVICES & MANAGEMENT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/24/2026
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

219 W BROWN ST
ENNIS TX
75119-4738
US

IV. Provider business mailing address

219 W BROWN ST
ENNIS TX
75119-4738
US

V. Phone/Fax

Practice location:
  • Phone: 817-219-4189
  • Fax: 972-875-3808
Mailing address:
  • Phone: 817-219-4189
  • Fax: 972-875-3808

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: ERIN JACKSON
Title or Position: OWNER
Credential: LPC-S
Phone: 817-219-4189