Individual
CHRISTOPHER JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1100 E SOUTHLAKE BLVD STE 200, SOUTHLAKE, TX 76092-6381
(817) 756-1293
Mailing address
14320 PADDEN PARK LN, ROANOKE, TX 76262-2140
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
83240
TX
Other
Enumeration date
06/05/2023
Last updated
06/05/2023
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