Individual
LUKE W JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LPC
Contact information
Practice address
2108 S 54TH ST STE 3, ROGERS, AR 72758-8125
(817) 201-5846
Mailing address
29 LEICESTER DR, BELLA VISTA, AR 72714-4100
(817) 201-5846
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
A2011175
—
101YM0800X
Mental Health Counselor
Primary
P2208022
AR
101YP2500X
Professional Counselor
—
—
Other
Enumeration date
12/21/2020
Last updated
12/06/2022
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