Provider Demographics
NPI:1477010502
Name:JACKSON, SHELIA SCALES
Entity type:Individual
Prefix:MRS
First Name:SHELIA
Middle Name:SCALES
Last Name:JACKSON
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 1:6527 W RIDGECREEK DR
Mailing Address - Street 2:
Mailing Address - City:MISSOURI CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77489-2825
Mailing Address - Country:US
Mailing Address - Phone:832-728-6405
Mailing Address - Fax:
Practice Address - Street 1:6527 W RIDGECREEK DR
Practice Address - Street 2:
Practice Address - City:MISSOURI CITY
Practice Address - State:TX
Practice Address - Zip Code:77489-2825
Practice Address - Country:US
Practice Address - Phone:832-728-6405
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-25
Last Update Date:2019-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No171W00000XOther Service ProvidersContractor
No174H00000XOther Service ProvidersHealth Educator