Healthcare Provider Details

I. General information

NPI: 1407640246
Provider Name (Legal Business Name): JEFFERY JACKSON LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/07/2025
Last Update Date: 04/08/2025
Certification Date: 04/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8575 COUNTY ROAD 534
WHITEWRIGHT TX
75491-7204
US

IV. Provider business mailing address

8575 COUNTY ROAD 534
WHITEWRIGHT TX
75491-7204
US

V. Phone/Fax

Practice location:
  • Phone: 940-447-1958
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number84985
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: