Individual
RUSSELL NEILEND JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHD
Contact information
Practice address
414 E BROADWAY STE 201A, COLUMBIA, MO 65201-4489
(515) 460-0047
Mailing address
PO BOX 843966, KANSAS CITY, MO 64184-3966
(573) 884-3300
(573) 884-0943
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
2021011992
MO
103TC1900X
Counseling Psychologist
2021011992
MO
103TP2701X
Group Psychotherapy Psychologist
Primary
2021011992
MO
Other
Enumeration date
01/07/2022
Last updated
09/29/2025
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