| NPI | 1598437089 |
|---|---|
| Former Name | BETH E. JACKSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MN 00073) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MN 300876) |
| Enumeration Date | 2021-10-02 |
| Last Update Date | 2021-10-02 |