Provider Demographics
NPI:1437783685
Name:MONICA P. JACKSON
Entity Type:Organization
Organization Name:MONICA P. JACKSON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ONWER/ADMINISTRATOR - LPC
Authorized Official - Prefix:MS
Authorized Official - First Name:MONICA
Authorized Official - Middle Name:P
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:MS, LCDC, LPC
Authorized Official - Phone:713-393-9779
Mailing Address - Street 1:PO BOX 1986
Mailing Address - Street 2:
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77305-1986
Mailing Address - Country:US
Mailing Address - Phone:832-323-9222
Mailing Address - Fax:832-442-4843
Practice Address - Street 1:24800 INTERSTATE 45 N STE 240
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77386-2347
Practice Address - Country:US
Practice Address - Phone:832-323-9222
Practice Address - Fax:832-442-4843
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MONICA P. JACKSON/JACAL & ASSOCIATES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-02-26
Last Update Date:2023-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty