Basic Information
| Provider Information | |||||||||
| NPI: | 1982131421 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JACKSON | ||||||||
| FirstName: | JALISA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3401 GARDEN OAKS DR APT 218 | ||||||||
| Address2: | |||||||||
| City: | NEW ORLEANS | ||||||||
| State: | LA | ||||||||
| PostalCode: | 701147717 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5043176417 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3308 TULANE AVE STE 407 | ||||||||
| Address2: | |||||||||
| City: | NEW ORLEANS | ||||||||
| State: | LA | ||||||||
| PostalCode: | 701197158 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5048216830 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/15/2017 | ||||||||
| LastUpdateDate: | 05/15/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | LA | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.