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NPI Code Detail

MEDICARE: KAREN ALEENE JACKSON

MEDICARE: KAREN ALEENE 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
1101Y00000XCounselor
2101YM0800XMental Health Counselor

General Provider Information

NPI Number : 1548312994
Entity Type Code : Individual
Provider Name (Legal Business Name) : KAREN ALEENE JACKSON
Provider Business Mailing Address
First Line : 4892 SAN PABLO DAM RD
Second Line :
City : EL SOBRANTE
State : CA
Zip : 94803-3222
Country : US
Telephone Number : 510-243-2360
Fax Number :
Provider Business Practice Location Address
First Line : 4892 SAN PABLO DAM RD
Second Line :
City : EL SOBRANTE
State : CA
Zip : 94803-3222
Country : US
Telephone Number : 510-243-2360
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/17/2007
Last Update Date : 11/08/2019

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