Provider Demographics
NPI:1477991818
Name:JACKSON, JANELLE L
Entity Type:Individual
Prefix:
First Name:JANELLE
Middle Name:L
Last Name:JACKSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5601 DEMOCRACY DR STE 135
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75024-3672
Mailing Address - Country:US
Mailing Address - Phone:479-464-1060
Mailing Address - Fax:
Practice Address - Street 1:5601 DEMOCRACY DR STE 135
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75024-3672
Practice Address - Country:US
Practice Address - Phone:501-944-0931
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-07
Last Update Date:2020-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor