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NPI Code Detail

MEDICARE: JANNIE TACKETT LPC

MEDICARE: JANNIE TACKETT LPC
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
1101YP2500XProfessional CounselorP1210095AR

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1124224035
Entity Type Code : Individual
Provider Name (Legal Business Name) : JANNIE TACKETT LPC
Provider Business Mailing Address
First Line : PO BOX 444
Second Line :
City : BAY
State : AR
Zip : 72411-0444
Country : US
Telephone Number : 870-613-1310
Fax Number :
Provider Business Practice Location Address
First Line : 3305 E HIGHLAND DR STE B
Second Line :
City : JONESBORO
State : AR
Zip : 72401-6491
Country : US
Telephone Number : 870-520-5015
Fax Number : 870-520-5015
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/26/2007
Last Update Date : 12/17/2025

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