Provider Demographics
NPI:1649054743
Name:LAUREN I JACKSON, PHD, PLLC
Entity type:Organization
Organization Name:LAUREN I JACKSON, PHD, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHRISTINA
Authorized Official - Middle Name:
Authorized Official - Last Name:PIERING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:469-236-1622
Mailing Address - Street 1:7810 AMHERST AVE
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75225-8201
Mailing Address - Country:US
Mailing Address - Phone:214-794-8507
Mailing Address - Fax:
Practice Address - Street 1:5555 ARAPAHO RD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75248-3442
Practice Address - Country:US
Practice Address - Phone:972-661-1880
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-21
Last Update Date:2023-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty