Provider Demographics
NPI:1912363300
Name:JACKSON, ERIN DENISE (LPC)
Entity Type:Individual
Prefix:MRS
First Name:ERIN
Middle Name:DENISE
Last Name:JACKSON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:219 W. BROWN ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:ENNIS
Mailing Address - State:TX
Mailing Address - Zip Code:75119
Mailing Address - Country:US
Mailing Address - Phone:817-219-4189
Mailing Address - Fax:972-875-3808
Practice Address - Street 1:219 W. BROWN ST
Practice Address - Street 2:SUITE A
Practice Address - City:ENNIS
Practice Address - State:TX
Practice Address - Zip Code:75119
Practice Address - Country:US
Practice Address - Phone:817-219-4189
Practice Address - Fax:972-875-3808
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-14
Last Update Date:2023-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX72161101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional