| NPI | 1215413406 |
|---|---|
| Former Name | SHELLEY CRAWFORD JACKSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: WA LH61025530) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: OR C5800) |
| Enumeration Date | 2018-07-11 |
| Last Update Date | 2025-02-22 |