| Tara Jackson Llc | |
|
2 Woodland Cir Durango CO 81301-4154 | |
| (970) 799-0765 | |
| Not Available |
| Full Name | Tara Jackson Llc |
|---|---|
| Speciality | Counselor - Professional |
| Location | 2 Woodland Cir, Durango, Colorado |
| Authorized Official Name and Position | Tara Jackson (OWNER) |
| Authorized Official Contact | 9707990765 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Tara Jackson Llc 2 Woodland Cir Durango CO 81301-4154 Ph: (970) 799-0765 | Tara Jackson Llc 2 Woodland Cir Durango CO 81301-4154 Ph: (970) 799-0765 |
| NPI Number | 1578147393 |
|---|---|
| Provider Enumeration Date | 05/07/2021 |
| Last Update Date | 05/07/2021 |
| Certification Date | 05/07/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1578147393 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YP2500X | Counselor - Professional | (* (Not Available)) | Primary |
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