Individual
CALVIN JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LPA
Contact information
Practice address
1311 N DIXIE HWY, ELIZABETHTOWN, KY 42701-2621
(270) 769-1304
(270) 234-8028
Mailing address
107 CRANES ROOST CT, ELIZABETHTOWN, KY 42701-3650
(270) 765-2605
(270) 766-1222
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
0274
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000338946
ANTHEM
KY
05
—
30605018
—
KS
Enumeration date
05/25/2006
Last updated
03/29/2008
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