Provider Demographics
NPI:1740640184
Name:JACKSON COUNSELING SERVICES
Entity type:Organization
Organization Name:JACKSON COUNSELING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:MS
Authorized Official - First Name:JENNELL
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:732-784-8309
Mailing Address - Street 1:PO BOX 1287
Mailing Address - Street 2:
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08754-1287
Mailing Address - Country:US
Mailing Address - Phone:732-431-0646
Mailing Address - Fax:
Practice Address - Street 1:130 W WATER ST.
Practice Address - Street 2:UNIT 1287
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08753-0875
Practice Address - Country:US
Practice Address - Phone:732-431-0646
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-27
Last Update Date:2022-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ311452OtherMEDICARE PTAN