Individual
MRS. MELISSA EILEEN JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPT
Contact information
Practice address
71175 AURORA RD, DESERT HOT SPRINGS, CA 92241-7631
(760) 251-8858
(760) 329-8889
Mailing address
71175 AURORA RD, DESERT HOT SPRINGS, CA 92241-7631
(760) 251-8858
(760) 329-8889
Taxonomy
Speciality
Code
Description
License number
State
167G00000X
Licensed Psychiatric Technician
Primary
35652
CA
225C00000X
Rehabilitation Counselor
BVNPT
CA
Other
Enumeration date
09/09/2021
Last updated
09/20/2021
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