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General NPI Number Information
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NPI Number | 1437783685
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Entity Type | Organization
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Legal Business Name | MONICA P. JACKSON
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Dates
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Enumeration Date | 02/26/2020
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Last Update Date | 08/12/2023
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Provider Practice Location Address
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Address Line | 24800 INTERSTATE 45 N STE 240
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City | SPRING
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State | TX
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Zip | 77386-2347
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Country | US
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Telephone | 832-323-9222
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Fax | 832-442-4843
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Provider Business Mailing Address
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Address Line | PO BOX 1986
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City | CONROE
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State | TX
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Zip | 77305-1986
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Country | US
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Telephone | 832-323-9222
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Fax | 832-442-4843
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Authorized Official
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Title or Position | ONWER/ADMINISTRATOR - LPC
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Name | MS. MONICA P. JACKSON
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Credential | MS., LCDC, LPC
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Telephone | 713-393-9779
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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 |
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License Number State |
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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 |
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License Number State |
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