Provider Demographics
NPI:1770367856
Name:NORRIS, JACKIE L (PLPC)
Entity type:Individual
Prefix:
First Name:JACKIE
Middle Name:L
Last Name:NORRIS
Suffix:
Gender:F
Credentials:PLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1759 E ELM ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65802-3227
Mailing Address - Country:US
Mailing Address - Phone:417-719-1440
Mailing Address - Fax:417-216-6769
Practice Address - Street 1:1759 E ELM ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65802-3227
Practice Address - Country:US
Practice Address - Phone:417-719-1440
Practice Address - Fax:417-216-6769
Is Sole Proprietor?:No
Enumeration Date:2023-08-21
Last Update Date:2023-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2016013856101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional