Jackson, Debra R

Jackson, Debra R is an individual health care provider with primary practice located at 4411 Dacoma St , Houston TX 77092-8611. She recently has only one registered license in Behavioral Health & Social Service Providers / Clinical, which is considered as her primary health care specialty. Jackson, Debra R can be contacted via phone (713) 686-9194.

Contact Information

Primary practice address
4411 Dacoma St Houston TX 77092-8611
Phone: (713) 686-9194
Fax: (713) 686-9413
Website:
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Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Clinical 1041C0700X 9360 Texas

Profile Details

NPI number 1154391050
LBN Legal business name Jackson, Debra R
Credentials Licensed Clinical Social Worker (LCSW)
Entity Individual
Sole proprietor 1 No
Enumeration date Jan 24th, 2006
Last updated Aug 9th, 2022 - about 2 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1154391050 NPPES
Texas MEDICAID 124171304

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