Individual
PHYLLIS JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
411 COLONIAL DR, BATON ROUGE, LA 70806-6506
(225) 926-9706
Mailing address
411 COLONIAL DR, BATON ROUGE, LA 70806-6506
(225) 926-9706
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Enumeration date
09/01/2016
Last updated
11/10/2016
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