Individual
MARY JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPC, TLAC
Contact information
Practice address
1201 WAKARUSA DR, STE E222, LAWRENCE, KS 66049-3882
(785) 843-5483
(785) 841-5433
Mailing address
1201 WAKARUSA DR, STE E222, LAWRENCE, KS 66049-3882
(785) 843-5483
(785) 841-5433
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
0730
KS
101YM0800X
Mental Health Counselor
Primary
2738
KS
Other
Enumeration date
07/29/2015
Last updated
03/05/2022
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