Provider Demographics
NPI:1265262901
Name:JACKSON STUART, JANIBELLE
Entity type:Individual
Prefix:
First Name:JANIBELLE
Middle Name:
Last Name:JACKSON STUART
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8517 PRIMROSE WILLOW PL
Mailing Address - Street 2:
Mailing Address - City:ODESSA
Mailing Address - State:FL
Mailing Address - Zip Code:33556-3252
Mailing Address - Country:US
Mailing Address - Phone:407-739-0580
Mailing Address - Fax:
Practice Address - Street 1:8517 PRIMROSE WILLOW PL
Practice Address - Street 2:
Practice Address - City:ODESSA
Practice Address - State:FL
Practice Address - Zip Code:33556-3252
Practice Address - Country:US
Practice Address - Phone:407-739-0580
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-06
Last Update Date:2024-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health