| Lacey Jackson Pllc | |
|
320 W Main St Ste 208 Murfreesboro TN 37130-3527 | |
| (931) 273-8888 | |
| Not Available |
| Full Name | Lacey Jackson Pllc |
|---|---|
| Speciality | Social Worker |
| Location | 320 W Main St Ste 208, Murfreesboro, Tennessee |
| Authorized Official Name and Position | Lacey Jackson (OWNER) |
| Authorized Official Contact | 9312738888 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Lacey Jackson Pllc 320 W Main St Ste 208 Murfreesboro TN 37130-3527 Ph: (931) 273-8888 | Lacey Jackson Pllc 320 W Main St Ste 208 Murfreesboro TN 37130-3527 Ph: (931) 273-8888 |
| NPI Number | 1285302851 |
|---|---|
| Provider Enumeration Date | 08/31/2021 |
| Last Update Date | 08/31/2021 |
| Certification Date | 08/31/2021 |
| Medicare PECOS PAC ID | 2567868144 |
|---|---|
| Medicare Enrollment ID | O20210907002185 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1285302851 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Lacey H Jackson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1710183686 PECOS PAC ID: 8729496732 Enrollment ID: I20210412001868 |
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