Individual
DAVID W JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LPCC
Contact information
Practice address
919 RENCHER ST, CLOVIS, NM 88101-5858
(575) 769-2142
(575) 769-2161
Mailing address
919 RENCHER ST, CLOVIS, NM 88101-5858
(575) 769-2142
(575) 769-2161
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
0089191
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
04937261
—
NM
Enumeration date
08/21/2009
Last updated
08/21/2009
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