Provider Demographics
NPI:1447590468
Name:JACKSON, TERRY ELIZABETH (LMHC)
Entity Type:Individual
Prefix:MRS
First Name:TERRY
Middle Name:ELIZABETH
Last Name:JACKSON
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6801 US HIGHWAY 27 N
Mailing Address - Street 2:SUITE A2
Mailing Address - City:SEBRING
Mailing Address - State:FL
Mailing Address - Zip Code:33870-7840
Mailing Address - Country:US
Mailing Address - Phone:863-382-0306
Mailing Address - Fax:
Practice Address - Street 1:6801 US HIGHWAY 27 N
Practice Address - Street 2:SUITE A2
Practice Address - City:SEBRING
Practice Address - State:FL
Practice Address - Zip Code:33870-7840
Practice Address - Country:US
Practice Address - Phone:863-382-0306
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-28
Last Update Date:2013-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH 11655101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health