Provider Demographics
NPI:1114194107
Name:JACKY, BEATRICE (LBSW)
Entity Type:Individual
Prefix:
First Name:BEATRICE
Middle Name:
Last Name:JACKY
Suffix:
Gender:F
Credentials:LBSW
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:713-527-8558
Practice Address - Street 1:8876 GULF FWY STE 420
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77017-6544
Practice Address - Country:US
Practice Address - Phone:713-807-1500
Practice Address - Fax:713-527-8558
Is Sole Proprietor?:No
Enumeration Date:2008-05-09
Last Update Date:2008-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX16037104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker