Russell Earl Jackson
Individual provider Active NPI Addiction (Substance Use Disorder) Counselor · Tupelo, MS
NPI 1164576476 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1164576476
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Addiction (Substance Use Disorder) Counselor 101YA0400X
- Practice address
- 920 Boone St
Tupelo, MS 38804-5908 - Phone
- (662) 844-3531
- Fax
- (662) 844-1757
- NPI assigned
- Jan 23, 2007
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | Yes |
Addresses
Primary practice location
920 Boone St
Tupelo, MS 38804-5908
Mailing address
PO Box 1943
Verona, MS 38879-1943
Phone (662) 566-7969
Other providers in Tupelo, MS
- George Jackson
- Jermie Micheal Jackson
- Jimmy R Jackson
- Robin Jackson
- Robin Jackson
- Valerie Jackson
- Amit Jain
- Jalopy Shoppe, Inc
- Annette C James
- Robert Wylie Jarrett Jr.
All providers in Tupelo, MS · Addiction (Substance Use Disorder) Counselor in Mississippi
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.