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General NPI Number Information
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NPI Number | 1285166066
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Entity Type | Individual
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Provider Name | CYNTHIA COLLINS-JACKSON LPC
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Gender | Female
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Dates
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Enumeration Date | 03/30/2017
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Last Update Date | 06/06/2024
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Provider Practice Location Address
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Address Line | 39 VILLAGE HILL DR
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City | CONROE
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State | TX
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Zip | 77304-3525
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Country | US
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Telephone | 936-520-9124
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Fax | 936-666-2291
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Provider Business Mailing Address
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Address Line | 39 VILLAGE HILL DR
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City | CONROE
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State | TX
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Zip | 77304-3525
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Country | US
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Telephone | 936-202-0596
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Fax | 936-666-2291
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 74855
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License Number State | TX
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