Provider Demographics
NPI:1013014117
Name:JACKSON, HELEN LAMAR (PHD)
Entity Type:Individual
Prefix:DR
First Name:HELEN
Middle Name:LAMAR
Last Name:JACKSON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6000 SUMMER AVE NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87110-6738
Mailing Address - Country:US
Mailing Address - Phone:505-266-4226
Mailing Address - Fax:505-265-3844
Practice Address - Street 1:6000 SUMMER AVE NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87110-6738
Practice Address - Country:US
Practice Address - Phone:505-266-4226
Practice Address - Fax:505-265-3844
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM334103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMN9626Medicaid