Individual
LYRIC LEANNA JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2900 E 29TH ST, BRYAN, TX 77802-2622
(979) 776-8440
Mailing address
4225 PENDLETON DR APT 2203, BRYAN, TX 77802-2684
(804) 385-5551
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
—
—
Other
Enumeration date
12/10/2021
Last updated
12/10/2021
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