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NPI Code Detail

MEDICARE: LIBBY LOUISE JACKSON

MEDICARE: LIBBY LOUISE 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
1106H00000XMarriage & Family Therapist137358CA
21041C0700XClinical Social Worker137358CA

General Provider Information

NPI Number : 1386483139
Entity Type Code : Individual
Provider Name (Legal Business Name) : LIBBY LOUISE JACKSON
Provider Business Mailing Address
First Line : 425 E SANTA CLARA ST
Second Line :
City : SAN JOSE
State : CA
Zip : 95113-1936
Country : US
Telephone Number : 669-245-3428
Fax Number :
Provider Business Practice Location Address
First Line : 425 E SANTA CLARA ST
Second Line :
City : SAN JOSE
State : CA
Zip : 95113-1936
Country : US
Telephone Number : 669-245-3428
Fax Number : 408-800-4095
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/22/2024
Last Update Date : 06/16/2026

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Directions to “ LIBBY LOUISE JACKSON ” Practice Location

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