Individual
NICOLE L JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
10922 SCHUETZ RD, SAINT LOUIS, MO 63146-5704
(314) 441-2737
Mailing address
10922 SCHUETZ RD, SAINT LOUIS, MO 63146-5704
(314) 441-2737
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
2013023409
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
490048738
—
MO
Enumeration date
09/02/2013
Last updated
11/21/2024
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