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Judith Ann Jackson
Mental Health Counselor in Santa Cruz, California
NPI 1104100775

Judith Ann Jackson is a Mental Health Counselor based in Santa Cruz, CA and is specialized in Mental Health. Judith Ann Jackson practices in Santa Cruz, CA. The NPI Number for Judith Ann Jackson is 1104100775 and holds a License No. (California).

The current practice location address for Judith Ann Jackson is 1400 Emeline Ave, Santa Cruz, CA and can be reached out via phone at 831-454-4971.

Location: 1400 Emeline Ave, Santa Cruz, CA, 95060-1976
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
person
Provider Profile Details
NPI Number
1104100775
Provider Name
Judith Ann Jackson
Credential
Provider Entity Type
Individual
Gender
Female
Address
1400 Emeline Ave, Santa Cruz, CA, 95060-1976
Phone Number
831-454-4971
Fax Number
Provider Enumeration Date
09/30/2011
Last Update Date
03/09/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
FHC70044F 01 CA COUNTY OF SANTA CRUZ MEDI-CAL PROVIDER#
FHC70042F 01 CA COUNTY OF SANTA CRUZ MEDI-CAL PROVIDER#
ZZZ91892Z 01 CA COUNTY OF SANTA CRUZ MEDICARE GROUP#
institution
Provider Business Practice Location Address Details
Address
1400 Emeline Ave
City
Santa Cruz
State
California
Zip
95060-1976
Phone Number
831-454-4971
Fax Number
person
Provider Business Mailing Address Details
Address
1400 Emeline Ave
City
Santa Cruz
State
California
Zip
95060-1976
Phone Number
831-454-4971
Fax Number
person
Provider's Taxonomy Details 1
Type
Behavioral Health & Social Service Providers
Classification
Counselor
Speciality
Mental Health
Taxonomy
101YM0800X
License No.
()
Definition
Definition to come...
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