Individual
MYLA ROSE JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PLMHP
Contact information
Practice address
200 N 34TH ST, NORFOLK, NE 68701-3197
(402) 371-3044
Mailing address
200 N 34TH ST, NORFOLK, NE 68701-3197
(402) 371-3044
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
12734
NE
Other
Enumeration date
08/25/2021
Last updated
08/25/2021
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