Individual
DR. JACOB JERRY JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PHD, LMHC, CADC
Contact information
Practice address
180 10TH ST SE STE 201, LE MARS, IA 51031-2557
(712) 546-4624
(712) 546-9395
Mailing address
180 10TH ST SE, LE MARS, IA 51031-2559
(712) 499-0207
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
15081
IA
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Enumeration date
10/11/2016
Last updated
11/06/2023
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