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1629520614
MICHEAL JACKSON
TALLULAH, LA
NPI
1629520614
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
Yes
Primary Taxonomy
101YM0800X Counselor, Mental Health
Enumeration Date
2016-10-26
Last Update Date
2016-10-26
Business Address
-- MICHEAL JACKSON
1705 FELICIA AVE
TALLULAH, LA 71282-8203
Phone number: 318-574-1232
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Mailing Address
-- MICHEAL JACKSON
1705 FELICIA AVE
TALLULAH, LA 71282-8203
Phone number: 318-574-1232
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