MEDICARE: BRITTNEY NICOLE JACKSON LPC-MHSP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	0000003600	TN

General Provider Information

NPI Number	:	1104343755
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRITTNEY NICOLE JACKSON LPC-MHSP

Provider Business Mailing Address
First Line	:	6551 STAGE OAKS DR STE 4
Second Line	:
City	:	BARTLETT
State	:	TN
Zip	:	38134-3895
Country	:	US
Telephone Number	:	901-387-0026
Fax Number	:

Provider Business Practice Location Address
First Line	:	6551 STAGE OAKS DR STE 4
Second Line	:
City	:	BARTLETT
State	:	TN
Zip	:	38134-3895
Country	:	US
Telephone Number	:	901-387-0026
Fax Number	:	901-552-4737

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/24/2017
Last Update Date	:	06/02/2020

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