person
Jean Petrilla Jackson, MA,LPC
Professional Counselor in Odessa, Texas
NPI 1710048830

Jean Petrilla Jackson is a Professional Counselor based in Odessa, TX and is specialized in Professional. Jean Petrilla Jackson practices in Odessa, TX and has the professional credentials of MA,LPC. The NPI Number for Jean Petrilla Jackson is 1710048830 and holds a License No. 14966 (Texas).

The current practice location address for Jean Petrilla Jackson is 855 Central Dr, Odessa, TX and can be reached out via phone at 432-580-7250 and via fax at 432-582-2020.

Location: 855 Central Dr, Odessa, TX, 79763-3546
person
Provider Profile Details
NPI Number
1710048830
Provider Name
Jean Petrilla Jackson
Credential
MA,LPC
Provider Entity Type
Individual
Gender
Female
Address
855 Central Dr, Odessa, TX, 79763-3546
Phone Number
432-580-7250
Fax Number
432-582-2020
Provider Enumeration Date
12/12/2006
Last Update Date
03/08/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
3710LC 01 TX BLUECROSS BLUESHIELD
5212693 01 AETNA
1296590 01 CIGNA
institution
Provider Business Practice Location Address Details
Address
855 Central Dr
City
State
Zip
79761-4200
Phone Number
432-580-7250
Fax Number
432-582-2020
person
Provider Business Mailing Address Details
Address
855 Central Dr
City
State
Zip
79761-4200
Phone Number
432-580-7250
Fax Number
432-582-2020
person
Provider's Taxonomy Details 1
Type
Behavioral Health & Social Service Providers
Classification
Counselor
Speciality
Professional
Taxonomy
License No.
14966 (Texas)
Definition
Definition to come...
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