Individual
MRS. MELISSA JEREE JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
13510 W YOUNG ST, SURPRISE, AZ 85374-5417
(262) 749-0908
Mailing address
13510 W YOUNG ST, SURPRISE, AZ 85374-5417
(262) 749-0908
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
LPC-15490
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
43599300
—
WI
Enumeration date
04/03/2007
Last updated
05/16/2024
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