Individual
DAVID K JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PHD MSCP
Contact information
Practice address
200 HENRY CLAY AVE, NEW ORLEANS, LA 70118-5911
(504) 896-7272
Mailing address
200 HENRY CLAY AVE, NEW ORLEANS, LA 70118-5720
(508) 896-7272
Taxonomy
Speciality
Code
Description
License number
State
103TP0016X
Prescribing (Medical) Psychologist
Primary
694MP
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1677833
—
LA
Enumeration date
01/19/2007
Last updated
05/07/2008
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