MEDICARE: MRS. RACHEL JACKSON WOOD LPC-A

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	97772	TX

General Provider Information

NPI Number	:	1528858578
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. RACHEL JACKSON WOOD LPC-A

Provider Business Mailing Address
First Line	:	6047 WAGGONER DR
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75230-4009
Country	:	US
Telephone Number	:	214-455-6030
Fax Number	:

Provider Business Practice Location Address
First Line	:	6047 WAGGONER DR
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75230-4009
Country	:	US
Telephone Number	:	214-455-6030
Fax Number	:

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

Provider Enumeration Date	:	05/12/2025
Last Update Date	:	06/09/2025

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