Individual provider · Type 1 NPI

Jessie R. Jackson

Child Mental Illness Respite Care · Tucson, AZ

NPI number 1104908417 Active

Practice location

9855 E Irvington Rd, Unit #82
Tucson, AZ 85730-5220

Call (520) 733-1165 Map

Fax (520) 733-1165

Specialties and licenses

TaxonomyCodeLicense
Child Mental Illness Respite Care Primary 385HR2055X3923 (AZ)

Child Mental Illness Respite Care: A facility or distinct part of a facility that provides short term, residential care to children, diagnosed with mental illness, as respite for the regular caregivers.

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About NPI 1104908417

Jessie R. Jackson's National Provider Identifier is 1104908417, issued on Oct 19, 2006. The primary taxonomy on file is Child Mental Illness Respite Care (385HR2055X), and the practice location is in Tucson, AZ. The record was last updated on Jul 9, 2007.