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General NPI Number Information
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NPI Number | 1649683988
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Entity Type | Individual
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Provider Name | BRITTANY A JACKSON LCPC
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Gender | Female
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Dates
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Enumeration Date | 06/04/2014
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 1010 E 79TH ST
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City | CHICAGO
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State | IL
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Zip | 60619-4442
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Country | US
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Telephone | 312-613-8792
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Fax |
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Provider Business Mailing Address
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Address Line | 8546 W 103RD TER APT 203
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City | PALOS HILLS
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State | IL
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Zip | 60465-1362
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Country | US
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Telephone | 312-613-8792
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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 | 178.010018
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License Number State | IL
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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 | 180.010945
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License Number State | IL
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