Provider Demographics
NPI:1346776135
Name:JACKIE RANSOM, LPC, LLC
Entity Type:Organization
Organization Name:JACKIE RANSOM, LPC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JACQUELINE
Authorized Official - Middle Name:ALLISON
Authorized Official - Last Name:RANSOM
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:816-456-7730
Mailing Address - Street 1:1000 W MAPLE AVE
Mailing Address - Street 2:
Mailing Address - City:INDEPENDENCE
Mailing Address - State:MO
Mailing Address - Zip Code:64050-3410
Mailing Address - Country:US
Mailing Address - Phone:816-785-7855
Mailing Address - Fax:
Practice Address - Street 1:10700 E WESTPORT RD
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:MO
Practice Address - Zip Code:64052-3470
Practice Address - Country:US
Practice Address - Phone:816-456-7730
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-11
Last Update Date:2017-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20130044752101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty