Provider Demographics
NPI:1376042259
Name:JACKSON, CIERRA (BCBA)
Entity Type:Individual
Prefix:
First Name:CIERRA
Middle Name:
Last Name:JACKSON
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:CIERRA
Other - Middle Name:
Other - Last Name:JACKSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7108 S KANNER HWY
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34997-7462
Mailing Address - Country:US
Mailing Address - Phone:855-832-6727
Mailing Address - Fax:772-675-9100
Practice Address - Street 1:903 PARKVIEW CIR
Practice Address - Street 2:
Practice Address - City:HEWITT
Practice Address - State:TX
Practice Address - Zip Code:76643-3265
Practice Address - Country:US
Practice Address - Phone:903-312-1315
Practice Address - Fax:866-790-8027
Is Sole Proprietor?:No
Enumeration Date:2018-02-06
Last Update Date:2023-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXRBT-18-49068106S00000X
TX1-20-45413103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1-20-45413OtherBACB
TXRBT-18-49068OtherBACB