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General NPI Number Information
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NPI Number | 1538674312
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Entity Type | Individual
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Provider Name | CHRISTOPHER D. JACKSON LPC
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Gender | Male
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Dates
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Enumeration Date | 12/03/2017
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Last Update Date | 02/08/2021
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Provider Practice Location Address
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Address Line | 2711 SAULSBURY DR
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City | TEMPLE
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State | TX
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Zip | 76504-2317
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Country | US
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Telephone | 254-800-2288
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Fax |
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Provider Business Mailing Address
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Address Line | 2711 SAULSBURY DR
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City | TEMPLE
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State | TX
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Zip | 76504-2317
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Country | US
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Telephone | 254-800-2288
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 008376
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License Number State | NY
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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 | 6786-125
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License Number State | WI
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