MEDICARE: CLIFTON JACKSON

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	101Y00000X	Counselor

General Provider Information

NPI Number	:	1326610965
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CLIFTON JACKSON

Provider Business Mailing Address
First Line	:	3520 E SHIELDS AVE
Second Line	:
City	:	FRESNO
State	:	CA
Zip	:	93726-6923
Country	:	US
Telephone Number	:	559-538-1727
Fax Number	:

Provider Business Practice Location Address
First Line	:	1555 SANTA CLARA ST
Second Line	:
City	:	FRESNO
State	:	CA
Zip	:	93706-9372
Country	:	US
Telephone Number	:	559-538-1230
Fax Number	:

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

Provider Enumeration Date	:	07/13/2021
Last Update Date	:	02/27/2023

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Directions to “ CLIFTON JACKSON ” Practice Location

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