Provider Demographics
NPI:1821206624
Name:JACKSON, CATRICE MARIE (LMHP,LPC)
Entity type:Individual
Prefix:MRS
First Name:CATRICE
Middle Name:MARIE
Last Name:JACKSON
Suffix:
Gender:F
Credentials:LMHP,LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3931 N 40TH AVE
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68111-2634
Mailing Address - Country:US
Mailing Address - Phone:402-502-2718
Mailing Address - Fax:
Practice Address - Street 1:6663 SORENSEN PKWY
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68152-2139
Practice Address - Country:US
Practice Address - Phone:402-502-9788
Practice Address - Fax:402-453-6768
Is Sole Proprietor?:No
Enumeration Date:2007-05-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2849101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health