Provider Demographics
NPI:1740318757
Name:JACKSON, JILL ROBIN (MA, LPC/MHSP)
Entity type:Individual
Prefix:MRS
First Name:JILL
Middle Name:ROBIN
Last Name:JACKSON
Suffix:
Gender:F
Credentials:MA, LPC/MHSP
Other - Prefix:MRS
Other - First Name:JILL
Other - Middle Name:ROBIN
Other - Last Name:JACKSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, LPC/MHSP
Mailing Address - Street 1:563 S. WATER AVE., SUITE E
Mailing Address - Street 2:
Mailing Address - City:GALLATIN
Mailing Address - State:TN
Mailing Address - Zip Code:37066
Mailing Address - Country:US
Mailing Address - Phone:615-527-3060
Mailing Address - Fax:615-206-8004
Practice Address - Street 1:563 S. WATER AVE., SUITE E
Practice Address - Street 2:
Practice Address - City:GALLATIN
Practice Address - State:TN
Practice Address - Zip Code:37066
Practice Address - Country:US
Practice Address - Phone:615-527-3060
Practice Address - Fax:615-206-8004
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-01
Last Update Date:2018-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1739101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health