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NPI Code Detail

MEDICARE: TRYNA JACKSON

MEDICARE: TRYNA 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
1101YM0800XMental Health Counselor89333TX

General Provider Information

NPI Number : 1538881206
Entity Type Code : Individual
Provider Name (Legal Business Name) : TRYNA JACKSON
Provider Business Mailing Address
First Line : PO BOX 2236
Second Line :
City : PFLUGERVILLE
State : TX
Zip : 78691-2236
Country : US
Telephone Number : 214-918-3775
Fax Number :
Provider Business Practice Location Address
First Line : 505 E HUNTLAND DR STE 320
Second Line :
City : AUSTIN
State : TX
Zip : 78752-3741
Country : US
Telephone Number : 512-201-4501
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/19/2022
Last Update Date : 09/19/2022

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Directions to “ TRYNA JACKSON ” Practice Location

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