Provider Demographics
NPI:1902388333
Name:WHITE-JACKSON, JUDY GAIL (MA, LPC)
Entity Type:Individual
Prefix:
First Name:JUDY
Middle Name:GAIL
Last Name:WHITE-JACKSON
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:JUDY
Other - Middle Name:G
Other - Last Name:WHITE-JACKSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:505 N SAM HOUSTON PKWY E STE 303
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77060-4086
Mailing Address - Country:US
Mailing Address - Phone:281-687-7053
Mailing Address - Fax:832-617-8347
Practice Address - Street 1:505 N SAM HOUSTON PKWY E STE 303
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77060-4086
Practice Address - Country:US
Practice Address - Phone:281-687-7053
Practice Address - Fax:832-617-8347
Is Sole Proprietor?:No
Enumeration Date:2018-09-01
Last Update Date:2020-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX76030101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional