Individual
SHALYSE A JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2101 TOWER DR, MONROE, LA 71201-5045
(318) 323-1300
Mailing address
2101 TOWER DR, MONROE, LA 71201-5045
(318) 323-1300
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
Other
Enumeration date
11/28/2023
Last updated
11/28/2023
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