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General NPI Number Information
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NPI Number | 1134374846
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Entity Type | Individual
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Provider Name | CHARITY FINCH JACKSON MS, LPC, BCN
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Gender | Female
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Dates
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Enumeration Date | 11/21/2008
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Last Update Date | 04/13/2023
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Provider Practice Location Address
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Address Line | 412 S CARROLL BLVD SUITE 2001
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City | DENTON
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State | TX
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Zip | 76201-7449
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Country | US
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Telephone | 940-220-1684
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Fax |
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Provider Business Mailing Address
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Address Line | 1335 PASEO DEL PUEBLO SUR # 249
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City | TAOS
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State | NM
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Zip | 87571-5972
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Country | US
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Telephone | 940-220-1684
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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 | 73299
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | CTB-2023-0017
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License Number State | NM
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