Provider Demographics
NPI:1902836877
Name:JACKSON, NATALIA OCOKOLJICH (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:NATALIA
Middle Name:OCOKOLJICH
Last Name:JACKSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:7212 JOLIET AVE
Mailing Address - Street 2:SUITE 10
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79423-1137
Mailing Address - Country:US
Mailing Address - Phone:806-791-2829
Mailing Address - Fax:806-791-3744
Practice Address - Street 1:7212 JOLIET AVE
Practice Address - Street 2:SUITE 10
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79423-1137
Practice Address - Country:US
Practice Address - Phone:806-791-2829
Practice Address - Fax:806-791-3744
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-04
Last Update Date:2016-12-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX330721041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX153798701Medicaid
TX87314QOtherBLUE CROSS/BLUE SHIELD