MEDICARE: CHANDRA 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
1	101YP2500X	Professional Counselor	97990	TX

General Provider Information

NPI Number	:	1811790553
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHANDRA JACKSON

Provider Business Mailing Address
First Line	:	2706 SE LOOP 820 # 1129
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76140-1011
Country	:	US
Telephone Number	:	817-325-8688
Fax Number	:

Provider Business Practice Location Address
First Line	:	835 SW ALSBURY BLVD UNIT I
Second Line	:
City	:	BURLESON
State	:	TX
Zip	:	76028-4094
Country	:	US
Telephone Number	:	682-325-8688
Fax Number	:

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

Provider Enumeration Date	:	03/28/2025
Last Update Date	:	11/18/2025

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Directions to “ CHANDRA JACKSON ” Practice Location

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