Individual
KEITH ELLIS JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LMFT
Contact information
Practice address
7600 NE 41ST ST STE 200, VANCOUVER, WA 98662-6772
(360) 852-8139
Mailing address
8600 NE 13TH PL, VANCOUVER, WA 98665-9534
(360) 852-8139
(360) 852-8139
Taxonomy
Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
Primary
48284
CA
106H00000X
Marriage & Family Therapist
LF61192417
WA
Other
Enumeration date
03/06/2021
Last updated
09/26/2024
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