| DC Jackson LLC | |
|
25 Grizzly Bear Run Rd Taos NM 87571 | |
| (505) 523-0066 | |
| Not Available |
| Full Name | DC Jackson LLC |
|---|---|
| Speciality | Clinic/center - Adult Mental Health |
| Location | 25 Grizzly Bear Run Rd, Taos, New Mexico |
| Authorized Official Name and Position | Charity Jackson (OWNER) |
| Authorized Official Contact | 9402201684 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| DC Jackson LLC 1335 Paseo Del Pueblo Sur # 249 Taos NM 87571-5972 Ph: (505) 523-0066 | DC Jackson LLC 25 Grizzly Bear Run Rd Taos NM 87571 Ph: (505) 523-0066 |
| NPI Number | 1265264857 |
|---|---|
| Provider Enumeration Date | 08/14/2024 |
| Last Update Date | 08/14/2024 |
| Certification Date | 08/13/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1265264857 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (NU) | Secondary |
| 261QM0850X | Clinic/center - Adult Mental Health | (NU) | Primary |
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