Provider Demographics
NPI:1114783578
Name:JACKSON, CECELIA CORD MORTON (LMFT)
Entity Type:Individual
Prefix:
First Name:CECELIA
Middle Name:CORD MORTON
Last Name:JACKSON
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1482 E VALLEY RD # 648
Mailing Address - Street 2:
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93108-1200
Mailing Address - Country:US
Mailing Address - Phone:805-452-7184
Mailing Address - Fax:
Practice Address - Street 1:615 STATE ST UNIT B
Practice Address - Street 2:
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93101-3301
Practice Address - Country:US
Practice Address - Phone:805-312-8078
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-23
Last Update Date:2024-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA114113106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty