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General NPI Number Information
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NPI Number | 1356269948
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Entity Type | Individual
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Provider Name | MIRANDA S JACKSON LPC
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Gender | Female
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Dates
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Enumeration Date | 07/09/2026
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Last Update Date | 07/09/2026
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Provider Practice Location Address
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Address Line | 1846 E ROSEMEADE PKWY # 1023
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City | CARROLLTON
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State | TX
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Zip | 75007-2637
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Country | US
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Telephone | 254-332-3430
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Fax |
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Provider Business Mailing Address
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Address Line | 3875 ANTIGUA CIR
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City | DALLAS
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State | TX
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Zip | 75244-6601
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Country | US
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Telephone | 254-332-3430
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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 | 97265
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License Number State | TX
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