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NPI Code Detail

MEDICARE: JACKSON HUSSEY

MEDICARE: JACKSON HUSSEY
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

General Provider Information

NPI Number : 1609623420
Entity Type Code : Individual
Provider Name (Legal Business Name) : JACKSON HUSSEY
Provider Business Mailing Address
First Line : 65 PROFESSIONAL PL STE 102
Second Line :
City : BRIDGEPORT
State : WV
Zip : 26330-0259
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 65 PROFESSIONAL PL STE 102
Second Line :
City : BRIDGEPORT
State : WV
Zip : 26330-0259
Country : US
Telephone Number : 304-848-5770
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/30/2024
Last Update Date : 04/14/2026

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Directions to “ JACKSON HUSSEY ” Practice Location

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