Provider Demographics
NPI:1669030649
Name:JACKSON, DENISE (MHS)
Entity Type:Individual
Prefix:
First Name:DENISE
Middle Name:
Last Name:JACKSON
Suffix:
Gender:F
Credentials:MHS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 CASENTINI ST
Mailing Address - Street 2:
Mailing Address - City:SALINAS
Mailing Address - State:CA
Mailing Address - Zip Code:93907-2299
Mailing Address - Country:US
Mailing Address - Phone:831-758-9457
Mailing Address - Fax:
Practice Address - Street 1:200 CASENTINI ST
Practice Address - Street 2:
Practice Address - City:SALINAS
Practice Address - State:CA
Practice Address - Zip Code:93907-2299
Practice Address - Country:US
Practice Address - Phone:831-758-9457
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-04
Last Update Date:2019-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor