Basic Information
| Provider Information | |||||||||
| NPI: | 1235572488 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | JACKSON | ||||||||
| FirstName: | HELEN | ||||||||
| MiddleName: | A. | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | LCPC, PSYD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 2025 | ||||||||
| Address2: | |||||||||
| City: | RIDGELAND | ||||||||
| State: | MS | ||||||||
| PostalCode: | 391582025 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7739720279 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1500 E WOODROW WILSON AVE | ||||||||
| Address2: | |||||||||
| City: | JACKSON | ||||||||
| State: | MS | ||||||||
| PostalCode: | 392165116 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6013624471 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/08/2013 | ||||||||
| LastUpdateDate: | 06/13/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | 180.007455 | IL | N | Behavioral Health & Social Service Providers | Counselor | Professional | 103TC0700X | 2353 | KS | N | Behavioral Health & Social Service Providers | Psychologist | Clinical | 103TC0700X | 55 987 | MS | Y | Behavioral Health & Social Service Providers | Psychologist | Clinical |
No ID Information.