Provider Demographics
NPI:1891578639
Name:JACKSON, LAURYN D (LPC-ASSOCIATE)
Entity Type:Individual
Prefix:
First Name:LAURYN
Middle Name:D
Last Name:JACKSON
Suffix:
Gender:F
Credentials:LPC-ASSOCIATE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:735 JUSTIN RD
Mailing Address - Street 2:
Mailing Address - City:ROCKWALL
Mailing Address - State:TX
Mailing Address - Zip Code:75087-4840
Mailing Address - Country:US
Mailing Address - Phone:682-757-7649
Mailing Address - Fax:
Practice Address - Street 1:735 JUSTIN RD
Practice Address - Street 2:
Practice Address - City:ROCKWALL
Practice Address - State:TX
Practice Address - Zip Code:75087-4840
Practice Address - Country:US
Practice Address - Phone:682-757-7649
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-15
Last Update Date:2023-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX92475101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor