Provider Demographics
NPI:1033585955
Name:JACKSON'S COUNSELING SERVICES, LLC
Entity Type:Organization
Organization Name:JACKSON'S COUNSELING SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROPRIETOR/PSYCHOTHERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:VALERIE
Authorized Official - Middle Name:F
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:810-845-6465
Mailing Address - Street 1:PO BOX 314
Mailing Address - Street 2:
Mailing Address - City:SWARTZ CREEK
Mailing Address - State:MI
Mailing Address - Zip Code:48473-0314
Mailing Address - Country:US
Mailing Address - Phone:810-845-6465
Mailing Address - Fax:
Practice Address - Street 1:G3163 FLUSHING RD
Practice Address - Street 2:SUITE 214
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48504-4365
Practice Address - Country:US
Practice Address - Phone:810-845-6465
Practice Address - Fax:810-733-7317
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-14
Last Update Date:2022-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801077180171M00000X
261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Single Specialty
No171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIMI5755OtherMEDICARE PTAN