Individual
BYRON JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
3101 N CENTRAL AVE # 220B, PHOENIX, AZ 85012-2645
(602) 920-2791
Mailing address
2320 E BASELINE RD STE 148-203, PHOENIX, AZ 85042-6959
(602) 920-2791
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
AZ
Other
Enumeration date
04/02/2020
Last updated
04/02/2020
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