Provider Demographics
NPI:1780955864
Name:JACKSON, KAREN P (LCSW, MFT)
Entity type:Individual
Prefix:MS
First Name:KAREN
Middle Name:P
Last Name:JACKSON
Suffix:
Gender:F
Credentials:LCSW, MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1105 TERMINAL WAY STE 202
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89502-2162
Mailing Address - Country:US
Mailing Address - Phone:775-786-1179
Mailing Address - Fax:
Practice Address - Street 1:1105 TERMINAL WAY STE 202
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89502-2162
Practice Address - Country:US
Practice Address - Phone:775-786-1179
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-20
Last Update Date:2012-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV355-C1041C0700X
NV326106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist