Organization
C MICHAELA JACKS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CRYSTAL M JACKS LMFT (SOLE MEMBER)
(412) 213-8425
Entity
Organization
Contact information
Practice address
1789 S BRADDOCK AVE STE 350, PITTSBURGH, PA 15218-1871
(412) 213-8425
Mailing address
1789 S BRADDOCK AVE STE 350, PITTSBURGH, PA 15218-1871
(412) 213-8425
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
MF000999
PA
Other
Enumeration date
04/25/2018
Last updated
05/01/2018
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