Provider Demographics
NPI:1235400268
Name:JACKSON, ROSE MARIE (LMSW-AB, LCDC, AAC)
Entity Type:Individual
Prefix:MS
First Name:ROSE
Middle Name:MARIE
Last Name:JACKSON
Suffix:
Gender:F
Credentials:LMSW-AB, LCDC, AAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6730 INDEPENDENCE BLVD
Mailing Address - Street 2:STE 300 TEXAS CHILD AND FAMILY INSTITUTE
Mailing Address - City:BAYTOWN
Mailing Address - State:TX
Mailing Address - Zip Code:77521-0205
Mailing Address - Country:US
Mailing Address - Phone:281-421-1524
Mailing Address - Fax:281-421-3484
Practice Address - Street 1:6730 INDEPENDENCE BOULEVARD, SUITE 300
Practice Address - Street 2:
Practice Address - City:BAYTOWN
Practice Address - State:TX
Practice Address - Zip Code:77521
Practice Address - Country:US
Practice Address - Phone:281-421-1524
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-23
Last Update Date:2012-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX05710101YP2500X
TX939101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional