| Jackson Psychotherapy, Llc | |
|
901 Kentucky St Ste 306 Lawrence KS 66044-2858 | |
| (816) 377-7398 | |
| (816) 873-1364 |
| Full Name | Jackson Psychotherapy, Llc |
|---|---|
| Speciality | Clinic/center - Mental Health (including Community Mental Health Center) |
| Location | 901 Kentucky St Ste 306, Lawrence, Kansas |
| Authorized Official Name and Position | Reginald C. Jackson (OWNER/PSYCHOTHERAPIST) |
| Authorized Official Contact | 8163777398 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Jackson Psychotherapy, Llc 901 Kentucky St Ste 306 Lawrence KS 66044-2858 Ph: (816) 377-7398 | Jackson Psychotherapy, Llc 901 Kentucky St Ste 306 Lawrence KS 66044-2858 Ph: (816) 377-7398 |
| NPI Number | 1578064861 |
|---|---|
| Provider Enumeration Date | 02/22/2018 |
| Last Update Date | 02/22/2018 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1578064861 | NPI | - | NPPES |
| 2015021883 | Medicaid | MO | |
| 4352 | Medicaid | KS | |
| 2015021883 | Other | MO | BCBS OF KANSAS CITY |
| 4352 | Other | KS | BCBS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | 4352 (Kansas) | Primary |
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