Provider Demographics
NPI:1760814396
Name:JACKSON, COURTNEY DANIELLE (BS)
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:DANIELLE
Last Name:JACKSON
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:COURTNEY
Other - Middle Name:
Other - Last Name:JACKSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:BS
Mailing Address - Street 1:534 E BASIN ST
Mailing Address - Street 2:
Mailing Address - City:NORRISTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19401-4068
Mailing Address - Country:US
Mailing Address - Phone:267-981-4823
Mailing Address - Fax:
Practice Address - Street 1:534 E BASIN ST
Practice Address - Street 2:
Practice Address - City:NORRISTOWN
Practice Address - State:PA
Practice Address - Zip Code:19401-4068
Practice Address - Country:US
Practice Address - Phone:267-981-4823
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-06
Last Update Date:2013-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health