Provider Demographics
NPI:1164968392
Name:JACKSON, DAVID MYERS (LMFT, MS, MAMFT)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:MYERS
Last Name:JACKSON
Suffix:
Gender:M
Credentials:LMFT, MS, MAMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:685 NW 5TH ST
Mailing Address - Street 2:STE A
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97330-6462
Mailing Address - Country:US
Mailing Address - Phone:541-757-1761
Mailing Address - Fax:
Practice Address - Street 1:685 NW 5TH ST
Practice Address - Street 2:STE A
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97330-6462
Practice Address - Country:US
Practice Address - Phone:541-757-1761
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-11
Last Update Date:2023-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORT1729106H00000X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist