# MR. RICHARD BRENDAN JACKSON

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1912500554
- **Gender:** Man
- **Credential:** LPC, LMAC-T

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 101YA0400X | Addiction (Substance Use Disorder) Counselor | 00906-T | KS | — |
| 101YM0800X | Mental Health Counselor | 03696 | KS | Yes |

## Other

- **Enumeration date:** 11/17/2020
- **Last updated:** 11/17/2020