Individual
MR. RICHARD BRENDAN JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LPC, LMAC-T
Contact information
Practice address
6221 RICHARDS DR, SHAWNEE, KS 66216-1724
(913) 248-1943
Mailing address
6221 RICHARDS DR, SHAWNEE, KS 66216-1724
(913) 248-1943
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
00906-T
KS
101YM0800X
Mental Health Counselor
Primary
03696
KS
Other
Enumeration date
11/17/2020
Last updated
11/17/2020
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