Organization
JACKSON PSYCHOTHERAPY, LLC
Active
Other names
The Satori Program
Organization subpart
No
Provider details
NPI number
Authorized official
REGINALD C. JACKSON LSCSW, LCSW (OWNER/EXECUTIVE DIRECTOR)
(816) 377-7398
Entity
Organization
Contact information
Practice address
901 KENTUCKY ST STE 306, LAWRENCE, KS 66044-2858
(816) 377-7398
(816) 873-1364
Mailing address
901 KENTUCKY ST STE 306, LAWRENCE, KS 66044-2858
(816) 377-7398
(816) 873-1364
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200629810C
—
KS
Enumeration date
08/07/2017
Last updated
07/21/2022
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