Individual
LISA R JACKSON-ZENO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
800 W 6TH ST STE 1505, LOS ANGELES, CA 90017-2742
(213) 760-4630
Mailing address
1343 W 90TH ST, LOS ANGELES, CA 90044-2031
(310) 686-6092
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
171W00000X
Contractor
Primary
—
—
Other
Enumeration date
07/08/2019
Last updated
01/14/2022
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