Healthcare Provider Details

I. General information

NPI: 1487001293
Provider Name (Legal Business Name): CAROL LYNN JACKSON LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/22/2016
Last Update Date: 09/30/2025
Certification Date: 09/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11380 STILES RD
PILOT POINT TX
76258-6044
US

IV. Provider business mailing address

11380 STILES RD
PILOT POINT TX
76258-6044
US

V. Phone/Fax

Practice location:
  • Phone: 214-546-9597
  • Fax:
Mailing address:
  • Phone: 214-546-9597
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number74943
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number74943
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: