Individual
MR. BRIAN M. JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
L.P.C.
Contact information
Practice address
91150 COBURG INDUSTRIAL WAY SERENITY LANE, COBURG, OR 97408
(541) 687-1110
Mailing address
P.O. BOX 8549 SERENITY LANE, 91150 COBURG INDUSTRIAL WAY, COBURG, OR 97408
(541) 687-1110
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
C5715
OR
101YP2500X
Professional Counselor
LPC-13803
AZ
Other
Enumeration date
12/13/2017
Last updated
04/08/2021
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