Jackson, Jean Petrilla

Jackson, Jean Petrilla is an sole proprietor health care provider with primary practice located at 855 Central Dr , Odessa TX 79761-4200. She recently has only one registered license in Behavioral Health & Social Service Providers / Professional, which is considered as her primary health care specialty. Jackson, Jean Petrilla can be contacted via phone (432) 580-7250.

Contact Information

Primary practice address
855 Central Dr Odessa TX 79761-4200
Phone: (432) 580-7250
Fax: (432) 582-2020
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Professional 101YP2500X 14966 Texas

Profile Details

NPI number 1710048830
LBN Legal business name Jackson, Jean Petrilla
Credentials MA, LPC
Entity Individual
Sole proprietor 1 Yes
Enumeration date Dec 12th, 2006
Last updated Jul 8th, 2007 - about 17 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 1710048830 NPPES
Texas Other 3710LC BLUECROSS BLUESHIELD
Texas Other 5212693 BLUECROSS BLUESHIELD
Texas Other 1296590 BLUECROSS BLUESHIELD

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