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NPI Code Detail

MEDICARE: VERONICA M JACKSON LPC MHSP

MEDICARE: VERONICA M JACKSON LPC MHSP
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
1101YP2500XProfessional Counselor0000001621TN

General Provider Information

NPI Number : 1811205347
Entity Type Code : Individual
Provider Name (Legal Business Name) : VERONICA M JACKSON LPC MHSP
Provider Business Mailing Address
First Line : 3385 AUSTIN PEAY HWY
Second Line :
City : MEMPHIS
State : TN
Zip : 38128-3810
Country : US
Telephone Number : 901-213-9000
Fax Number :
Provider Business Practice Location Address
First Line : 3385 AUSTIN PEAY HWY
Second Line :
City : MEMPHIS
State : TN
Zip : 38128-3810
Country : US
Telephone Number : 901-213-9000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/17/2010
Last Update Date : 09/17/2010

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Directions to “ VERONICA M JACKSON LPC MHSP” Practice Location

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