Individual
MARCUS JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
4954 E 56TH ST STE 4, INDIANAPOLIS, IN 46220-5769
(317) 941-7387
Mailing address
4954 E 56TH ST STE 4, INDIANAPOLIS, IN 46220-5769
(317) 941-7387
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
—
—
171M00000X
Case Manager/Care Coordinator
—
—
171W00000X
Contractor
—
—
172V00000X
Community Health Worker
—
—
251B00000X
Case Management Agency
Primary
—
—
Other
Enumeration date
08/20/2024
Last updated
08/20/2024
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