Individual
DR. TAMMY LYNN JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PH.D.
Contact information
Practice address
1014 SUN MEADOW CT, COLLEGE STATION, TX 77845-7291
(979) 217-1311
(855) 604-0969
Mailing address
1014 SUN MEADOW CT, COLLEGE STATION, TX 77845-7291
(979) 217-1311
(855) 604-0969
Taxonomy
Speciality
Code
Description
License number
State
103TA0700X
Adult Development & Aging Psychologist
Primary
31418
TX
103TB0200X
Cognitive & Behavioral Psychologist
31418
TX
103TC1900X
Counseling Psychologist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
158249604
—
TX
Enumeration date
11/07/2005
Last updated
08/25/2023
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