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Individual
MARY JACKSON
Active
Individual
MARY JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCPC, LCAC, LPC
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
0730
KS
101YM0800X
Mental Health Counselor
Primary
2738
KS
101YP2500X
Professional Counselor
Primary
2738
KS
Other
Enumeration date
07/29/2015
Last updated
06/03/2026
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