Individual
BRUCE JACKSON III
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
21727 W INTERSTATE 10 STE 108, SAN ANTONIO, TX 78257-2108
(210) 455-1091
Mailing address
5510 MOSS GLENN LN, HOUSTON, TX 77088-5533
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
25-470268
TX
Other
Enumeration date
09/24/2025
Last updated
09/24/2025
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