Individual
AMY JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MED COUNSELING
Contact information
Practice address
1100 LYONS AVE, SOUTH LAKE TAHOE, CA 96150-8252
(530) 307-4046
Mailing address
1100 LYONS AVE, SOUTH LAKE TAHOE, CA 96150-8252
(530) 307-4046
Taxonomy
Speciality
Code
Description
License number
State
101YS0200X
School Counselor
Primary
—
CA
Other
Enumeration date
11/25/2024
Last updated
11/25/2024
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