Individual
IREE JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LAC
Contact information
Practice address
404 E CRAIG ST, TALLULAH, LA 71282-3718
(318) 574-4164
(318) 574-4164
Mailing address
815 W CRAIG STREET, TALLULAH, LA 71282
(318) 574-4776
(318) 574-4164
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
823
LA
Other
Enumeration date
02/05/2016
Last updated
02/05/2016
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