Provider Demographics
NPI:1124224035
Name:TACKETT, JANNIE (LPC)
Entity Type:Individual
Prefix:
First Name:JANNIE
Middle Name:
Last Name:TACKETT
Suffix:
Gender:F
Credentials:LPC
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 444
Mailing Address - Street 2:
Mailing Address - City:BAY
Mailing Address - State:AR
Mailing Address - Zip Code:72411-0444
Mailing Address - Country:US
Mailing Address - Phone:870-613-1310
Mailing Address - Fax:
Practice Address - Street 1:101 S CHURCH ST STE 201
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72401-2994
Practice Address - Country:US
Practice Address - Phone:870-613-1310
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-26
Last Update Date:2024-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARP1210095101YP2500X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional