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Individual

DR. VICKIE JACKSON

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
PH.D.

Contact information

Practice address
14740 BARRYKNOLL LN, 130, HOUSTON, TX 77079-2884
(281) 497-0201
(281) 679-6545
Mailing address
702 HOUGHTON RD, KATY, TX 77450-2229
(281) 497-0201

Taxonomy

Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
23227
TX

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
2-3227
LICENSURE NUMBER
TX
01
B97A
BLUE CROSS BLUE SHIELD
TX
Enumeration date
08/11/2006
Last updated
07/08/2007
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