Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225C00000X | Rehabilitation Counselor | BVNPT | CA |
NPI | 1235808551 |
---|---|
Provider Name | Mrs. Melissa Eileen Jackson |
First Address | Desert Hot Springs, CA 92241-7631 |
Second Address | Desert Hot Springs, CA 92241-7631 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/09/2021 |
Last Update Date | 20/09/2021 |