Individual
TONYA JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MT-BC
Contact information
Practice address
1500 E WOODROW WILSON AVE, JACKSON, MS 39216-5116
(601) 362-4471
Mailing address
146 RAMSEY CIR, RUSTON, LA 71270-1693
(910) 548-4120
Taxonomy
Speciality
Code
Description
License number
State
225A00000X
Music Therapist
Primary
06219
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
06219
CBMT
WI
Enumeration date
05/13/2021
Last updated
05/13/2021
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