Provider Demographics
NPI:1093916553
Name:JACKSON, CAREY LYNN (MA, LPC-S)
Entity Type:Individual
Prefix:
First Name:CAREY
Middle Name:LYNN
Last Name:JACKSON
Suffix:
Gender:F
Credentials:MA, LPC-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 890008
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77289-0008
Mailing Address - Country:US
Mailing Address - Phone:713-807-1500
Mailing Address - Fax:
Practice Address - Street 1:8876 GULF FWY
Practice Address - Street 2:STE 415
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77017-6513
Practice Address - Country:US
Practice Address - Phone:713-807-1500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-30
Last Update Date:2013-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX62953101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor