Tierra Jackson LPCA, LMFTA, RMFTI

NPI 1225440548 - Marriage & Family Therapist - 106H00000X

NPI Details
NPI 1225440548
Gender Female
Enumeration Date 05/21/2014
Last Updated 12/17/2014
Entity Type Individual
Active Over 2 years ago
Practice Location
4680 LIPSCOMB ST NE
SUITE 10A
PALM BAY FL, 32905-2984, US
Phone (321) 433-3570
Fax
Business Location
910 UTE TRL
PATRICK AFB FL, 32925-3160, US
Phone (828) 994-7718
Fax
Toxanomy
Taxonomy Code 106H00000X
License State North Carolina
License Number 9096A
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According to our database, Mrs. Tierra Jackson LPCA, LMFTA, RMFTI NPI is 1225440548, taxonomy code is 106H00000X and license number is 9096A, license state is located at North Carolina. Tierra Jackson LPCA, LMFTA, RMFTI physically located at 4680 Lipscomb St Ne, Palm Bay FL, 32905-2984. NPI Number Tierra Jackson LPCA, LMFTA, RMFTI has the Individual type.

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1225440548 NPI number is provided on an as is basis without warranty of any kind. 1225440548 is maintained by the National Plan & Provider Enumeration System. The contents of Tierra Jackson LPCA, LMFTA, RMFTI are for informational purposes only.