Provider Demographics
NPI:1033448824
Name:JACKSON CONSULTING LLC
Entity type:Organization
Organization Name:JACKSON CONSULTING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:FAYE
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:205-999-3701
Mailing Address - Street 1:5780 HERITAGE PARK DR
Mailing Address - Street 2:
Mailing Address - City:MC CALLA
Mailing Address - State:AL
Mailing Address - Zip Code:35111-3490
Mailing Address - Country:US
Mailing Address - Phone:205-313-6432
Mailing Address - Fax:205-313-6431
Practice Address - Street 1:1 CHASE CORPORATE CENTER DRIVE
Practice Address - Street 2:SUITE 400
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35244
Practice Address - Country:US
Practice Address - Phone:205-313-6432
Practice Address - Fax:205-313-6431
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-08
Last Update Date:2009-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1322251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health