Individual
HEATHER LEANN JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPCC
Contact information
Practice address
SIMMONS ELEMENTARY HEALTHY KIDS CLINIC, 830 TYRONE PIKE, VERSAILLES, KY 40383-1323
(844) 435-0900
(270) 858-4029
Mailing address
PO BOX 1080, BURKESVILLE, KY 42717-1080
(270) 858-6655
(270) 858-4027
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
169029
KY
101YP2500X
Professional Counselor
Primary
283493
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1679948491
—
KY
Enumeration date
12/04/2015
Last updated
01/09/2024
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