Provider Demographics
NPI:1598005811
Name:JACKMAN, STEVEN R (LPC)
Entity Type:Individual
Prefix:MR
First Name:STEVEN
Middle Name:R
Last Name:JACKMAN
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1101 E PLANO PKWY
Mailing Address - Street 2:SUITE F
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75074-8541
Mailing Address - Country:US
Mailing Address - Phone:214-597-1405
Mailing Address - Fax:
Practice Address - Street 1:1101 E PLANO PKWY
Practice Address - Street 2:SUITE F
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75074-8541
Practice Address - Country:US
Practice Address - Phone:214-597-1405
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-22
Last Update Date:2013-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX66147101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional