Individual
AMANDA JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3406 LAUGHLIN ST, DERBY, KS 67037-2309
(316) 789-4116
Mailing address
3406 LAUGHLIN ST, DERBY, KS 67037-2309
(316) 789-4116
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Enumeration date
07/15/2021
Last updated
07/15/2021
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