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NPI Code Detail

MEDICARE: MS. DEBRA R JACKSON LCSW

MEDICARE: MS. DEBRA R JACKSON LCSW
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
11041C0700XClinical Social Worker9360TX

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 : 1154391050
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. DEBRA R JACKSON LCSW
Provider Business Mailing Address
First Line : 101 FEU FOLLET RD STE 100
Second Line :
City : LAFAYETTE
State : LA
Zip : 70508-4234
Country : US
Telephone Number : 713-686-9194
Fax Number : 713-686-9413
Provider Business Practice Location Address
First Line : 1214 N POST OAK RD STE 100
Second Line :
City : HOUSTON
State : TX
Zip : 77055-7236
Country : US
Telephone Number : 713-686-9194
Fax Number : 713-686-9413
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/24/2006
Last Update Date : 11/25/2025

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