Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101Y00000X | Counselor | LA | |
N | 101YA0400X | Addiction Counselor (Substance Use Disorder) | LA | |
N | 101YM0800X | Mental Health Counselor | LA | |
N | 101YP2500X | Professional Counselor | LA | |
N | 103K00000X | Behavior Analyst | LA | |
N | 103TC2200X | Clinical Child & Adolescent Psychologist | LA | |
N | 103TR0400X | Rehabilitation Psychologist | LA | |
N | 104100000X | Social Worker | LA | |
N | 1041C0700X | Clinical Social Worker | LA |
NPI | 1013391176 |
---|---|
Provider Name | Kendrick Jackson |
First Address | Natchitoches, LA 71457-4612 |
Second Address | Natchitoches, LA 71457-4612 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/07/2015 |
Last Update Date | 17/07/2015 |