Organization
HIDING PLACE INDIVIDUAL FAMILY AND MARRIAGE THERAPY PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. EDWARD JACKSON JR. LMFT (MEMBER/OWNER)
(716) 201-0522
Entity
Organization
Contact information
Practice address
1868 NIAGARA FALLS BLVD STE 103, TONAWANDA, NY 14150-6494
(716) 201-0522
Mailing address
1868 NIAGARA FALLS BLVD STE 103, TONAWANDA, NY 14150-6494
(716) 201-0522
Taxonomy
Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
Primary
—
—
Other
Enumeration date
09/11/2023
Last updated
01/03/2024
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