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General NPI Number Information
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NPI Number | 1760997217
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Entity Type | Organization
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Legal Business Name | NAOMI JACKSON THE PROFESSION OF MARRIAGE AND FAMILY THERAPY
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Dates
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Enumeration Date | 12/06/2017
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Last Update Date | 12/06/2017
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Provider Practice Location Address
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Address Line | 101 E REDLANDS BLVD STE 246
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City | REDLANDS
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State | CA
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Zip | 92373-4725
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Country | US
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Telephone | 909-674-4289
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Fax | 909-363-8977
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Provider Business Mailing Address
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Address Line | 101 E REDLANDS BLVD STE 246
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City | REDLANDS
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State | CA
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Zip | 92373-4725
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Country | US
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Telephone | 909-674-4289
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Fax | 909-363-8977
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Authorized Official
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Title or Position | OWNER
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Name | NAOMI ELNORA JACKSON
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Credential | LMFT
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Telephone | 909-674-4289
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | LMFT80560
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License Number State | CA
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