Jackson, Nicole L

Jackson, Nicole L is an individual health care provider with primary practice located at 3394 Mckelvey Rd Ste 116 , Bridgeton MO 63044-2531. She recently has only one registered license in Behavioral Health & Social Service Providers / Professional, which is considered as her primary health care specialty. Jackson, Nicole L can be contacted via phone (314) 656-6153.

Contact Information

Primary practice address
3394 Mckelvey Rd Ste 116 Bridgeton MO 63044-2531
Phone: (314) 656-6153
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Professional 101YP2500X 2013023409 Missouri

Profile Details

NPI number 1053745521
LBN Legal business name Jackson, Nicole L
Credentials Licensed Professional Counselor (LPC)
Entity Individual
Sole proprietor 1 No
Enumeration date Sep 2nd, 2013
Last updated May 21st, 2020 - about 4 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 1053745521 NPPES
Missouri MEDICAID 490048738

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