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General NPI Number Information
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NPI Number | 1659897593
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Entity Type | Individual
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Provider Name | LAMECIA LASHAY JACKSON LMT, CA
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Gender | Female
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Dates
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Enumeration Date | 08/22/2017
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Last Update Date | 01/26/2023
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Provider Practice Location Address
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Address Line | 530 N ESTRELLA PKWY #0-1
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City | GOODYEAR
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State | AZ
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Zip | 85338
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Country | US
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Telephone | 623-932-9211
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Fax |
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Provider Business Mailing Address
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Address Line | 5830 W THUNDERBIRD RD # B8216
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City | GLENDALE
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State | AZ
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Zip | 85306-4654
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Country | US
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Telephone | 623-203-8864
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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 | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | MT-07028
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License Number State | AZ
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