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General NPI Number Information
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NPI Number | 1124224035
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Entity Type | Individual
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Provider Name | JANNIE TACKETT LPC
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Gender | Female
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Dates
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Enumeration Date | 06/26/2007
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Last Update Date | 11/20/2025
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Provider Practice Location Address
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Address Line | 3305 E HIGHLAND DR STE B
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City | JONESBORO
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State | AR
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Zip | 72401-6491
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Country | US
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Telephone | 870-520-5015
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Fax | 870-520-5015
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Provider Business Mailing Address
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Address Line | PO BOX 444
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City | BAY
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State | AR
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Zip | 72411-0444
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Country | US
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Telephone | 870-613-1310
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | P1210095
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License Number State | AR
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