| Crystal A. Jackson, Ph.d. , Llp, Llc | |
|
3011 W Grand Blvd Detroit MI 48202-3096 | |
| (586) 943-0563 | |
| Not Available |
| Full Name | Crystal A. Jackson, Ph.d. , Llp, Llc |
|---|---|
| Speciality | Psychologist |
| Location | 3011 W Grand Blvd, Detroit, Michigan |
| Authorized Official Name and Position | Crystal A Jackson (OWNER/PSYCHOLOGIST) |
| Authorized Official Contact | 5869430563 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Crystal A. Jackson, Ph.d. , Llp, Llc 3011 W Grand Blvd Ste 413 Detroit MI 48202-3011 Ph: (586) 943-0563 | Crystal A. Jackson, Ph.d. , Llp, Llc 3011 W Grand Blvd Detroit MI 48202-3096 Ph: (586) 943-0563 |
| NPI Number | 1073124772 |
|---|---|
| Provider Enumeration Date | 08/14/2020 |
| Last Update Date | 10/19/2020 |
| Certification Date | 10/19/2020 |
| Medicare PECOS PAC ID | 5799105623 |
|---|---|
| Medicare Enrollment ID | O20201015000779 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1073124772 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103T00000X | Psychologist | (* (Not Available)) | Primary |
| Provider Name | Crystal A. Jackson |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1255595948 PECOS PAC ID: 6608296538 Enrollment ID: I20201118002352 |
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