Individual
TAYANNA I JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2490 LEE BLVD STE 103, CLEVELAND HEIGHTS, OH 44118-1255
(216) 835-5212
Mailing address
2490 LEE BLVD STE 103, CLEVELAND HEIGHTS, OH 44118-1255
(216) 835-5212
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
OH
172V00000X
Community Health Worker
Primary
—
OH
Other
Enumeration date
07/18/2018
Last updated
07/18/2018
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