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General NPI Number Information
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NPI Number | 1285853481
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Entity Type | Individual
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Provider Name | JOHN EDWARD JACKSON BS MS,LMHC,CAP
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Gender | Male
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Dates
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Enumeration Date | 04/25/2007
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 1851 NW 123RD AVE
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City | PEMBROKE PINES
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State | FL
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Zip | 33026-3825
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Country | US
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Telephone | 954-432-2100
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Fax |
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Provider Business Mailing Address
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Address Line | 6022 NW 91ST WAY
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City | TAMARAC
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State | FL
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Zip | 33321-4100
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Country | US
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Telephone | 954-720-5523
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 3282
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | MH8379
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License Number State | FL
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