Shane Michell Jackson in Gilmer - Addiction (substance Use Disorder)
Shane Michell Jackson - NPI 1922173897
Shane Michell Jackson is a Addiction (substance Use Disorder) in Gilmer, Texas. Shane Michell Jackson practices all healthcare services and medical treatments related to Addiction (substance Use Disorder). The NPI Number for Shane Michell Jackson is 1922173897. The last update date is 2007-07-08.
Shane Michell Jackson's current location address is Po Box 1551, Gilmer, Texas. You can contact this provider via phone number 9037467643 and fax number 9038434336. The mailing address for Shane Michell Jackson is Po Box 1551, Gilmer, Texas. To know further, please read the information below!
Provider Profile Detail
| Provider Name | Shane Michell Jackson |
|---|---|
| Address | Po Box 1551, Gilmer, Texas |
| Phone Number | 9037467643 |
| Fax Number | 9038434336 |
| Sole Proprietor | Y |
| Credentials | LPC |
NPI Number Detail
| NPI Number | 1922173897 |
|---|---|
| Provider Enumeration Date | 2006-11-22 |
| Last Updated Date | 2007-07-08 |
Provider Mailing Address Detail
| Address | Po Box 1551 |
|---|---|
| City | Gilmer |
| State | Texas (TX) |
| Post Code | 756441551 |
| Phone Number | 9037467643 |
| Fax Number | 9038434336 |
Provider's Primary Taxonomy Detail
| Speciality | Addiction (substance Use Disorder) |
|---|---|
| Taxonomy | 101Ya0400X |
| Licence No | 4128 |
|
Definition: A counselor who helps people with alcohol, drug, gambling, internet, and other types of addictions. |
|
Provider's Other Legacy Identifiers
| Identifier | Identifier Type | Identifier State | Identifier Issuer |
|---|---|---|---|
| 16480 | TX | LPC | |
| 4128 | TX | LCDC |
Post Comment/ Review Below
What is the unique identification code assigned to Shane Michell Jackson by the Centers for Medicare & Medicaid Services?
The Shane Michell Jackson has been issued the NPI (National Provider Identifier) 1922173897. This 10-digit code serves as a unique identifier for healthcare providers, assigned by the Centers for Medicare & Medicaid Services (CMS).
Could you provide the complete physical address where Shane Michell Jackson is located?
The Shane Michell Jackson is situated at the following address: Po Box 1551, Gilmer, TX, 756441551.
What is Shane Michell Jackson's primary area of medical expertise, and what taxonomy classification code corresponds to this specialized field?
The primary area of medical expertise for Shane Michell Jackson is Addiction (substance Use Disorder), and the corresponding taxonomy classification code for this specialized field is 101Ya0400X.
On what date did the Shane Michell Jackson receive the assignment of its 1922173897 from the Centers for Medicare & Medicaid Services?
The Shane Michell Jackson was issued its 1922173897 by the Centers for Medicare & Medicaid Services on 2006-11-22.
When was the information pertaining to Shane Michell Jackson most recently updated or revised?
The details related to Shane Michell Jackson, including its address, specialty, and other relevant information, were last updated or revised on 2007-07-08.