Organization
JACKSON PSYCHOTHERAPY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
REGINALD C. JACKSON LSCSW, LCSW (OWNER/PSYCHOTHERAPIST)
(816) 377-7398
Entity
Organization
Contact information
Practice address
901 KENTUCKY ST STE 306, LAWRENCE, KS 66044-2858
(816) 377-7398
(816) 873-1364
Mailing address
901 KENTUCKY ST STE 306, LAWRENCE, KS 66044-2858
(816) 377-7398
(816) 377-7398
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
4352
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2015021883
BCBS OF KANSAS CITY
MO
05
—
2015021883
—
MO
01
—
4352
BCBS
KS
05
—
4352
—
KS
Enumeration date
02/22/2018
Last updated
02/22/2018
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