Provider Demographics
NPI:1669647913
Name:M HOPE JACKSON PHD LLC
Entity Type:Organization
Organization Name:M HOPE JACKSON PHD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MELANIE
Authorized Official - Middle Name:HOPE
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:251-470-7607
Mailing Address - Street 1:2864 DAUPHIN ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36606-2479
Mailing Address - Country:US
Mailing Address - Phone:251-470-7607
Mailing Address - Fax:251-470-7609
Practice Address - Street 1:2864 DAUPHIN ST
Practice Address - Street 2:SUITE A
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36606-2479
Practice Address - Country:US
Practice Address - Phone:251-470-7607
Practice Address - Fax:251-470-7609
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-28
Last Update Date:2008-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1369103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL1619953726OtherTYPE 1 NPI