Provider Demographics
NPI:1144576356
Name:BARKER JACKSON & ASSOCIATES
Entity Type:Organization
Organization Name:BARKER JACKSON & ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW,ACSW,LCDC,DAPA,
Authorized Official - Phone:512-638-2366
Mailing Address - Street 1:407 CANYON CREEK DR
Mailing Address - Street 2:SUITE 103 PMB 3203
Mailing Address - City:TEMPLE
Mailing Address - State:TX
Mailing Address - Zip Code:76502-3291
Mailing Address - Country:US
Mailing Address - Phone:512-638-2366
Mailing Address - Fax:
Practice Address - Street 1:1810 MARLANDWOOD RD
Practice Address - Street 2:8207
Practice Address - City:TEMPLE
Practice Address - State:TX
Practice Address - Zip Code:76502-2819
Practice Address - Country:US
Practice Address - Phone:512-638-2366
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BARKER JACKSON & ASSOCIATES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-07-25
Last Update Date:2012-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX50146251S00000X
TX10476251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health