NPI 1003329160

Staci Nicole Jackson

Practitioner Mental Health Counselor Baton Rouge, LA

Practice location

Address: 11616 Southfork Ave, Baton Rouge, LA 70816-5241
Phone: (225) 291-9646

Registered specialties

Mental Health Counselor Primary

Behavioral Health & Social Service Providers Taxonomy 101YM0800X

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Registry record

NPI: 1003329160
Entity type: Individual
Sex (as registered): Female
NPI issued: 13 Nov 2017
Record last updated: 13 Nov 2017

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.