Individual
TAYE-RAFAEL JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1028 E WORTHY ST, GONZALES, LA 70737-4367
(504) 399-9851
Mailing address
5850 GRANITE PKWY, PLANO, TX 75024-6748
(225) 313-2800
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
04/19/2023
Last updated
04/19/2023
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