Individual
MR. EDWARD L JACKSON JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LPC
Contact information
Practice address
7750 CLAYTON RD, SUITE 103, SAINT LOUIS, MO 63117-1353
(314) 647-7708
(314) 645-0359
Mailing address
3807 KEENELAND CT, FLORISSANT, MO 63034-3350
(314) 921-2893
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
002498
MO
Other
Enumeration date
12/08/2006
Last updated
07/08/2007
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