Provider Demographics
NPI:1558989541
Name:JACKSON, SEAN (RBT, CPR)
Entity Type:Individual
Prefix:
First Name:SEAN
Middle Name:
Last Name:JACKSON
Suffix:
Gender:M
Credentials:RBT, CPR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24124 CINCO VILLAGE CENTER BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77494-8389
Mailing Address - Country:US
Mailing Address - Phone:832-263-6634
Mailing Address - Fax:
Practice Address - Street 1:24124 CINCO VILLAGE CENTER BLVD STE 200
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77494-8389
Practice Address - Country:US
Practice Address - Phone:832-263-6634
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-07
Last Update Date:2020-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXRBT-18-65590103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst