Individual provider · Type 1 NPI

Roger Dale Jackson, MA

Mental Health Counselor · Merrillville, IN

NPI number 1366957342 Active

Practice location

8200 Georgia St
Merrillville, IN 46410-6227

Fax (219) 791-1422

Mailing address

3021 E 36th Ave
Lake Station, IN 46405-2966

Specialties and licenses

TaxonomyCodeLicense
Mental Health Counselor Primary 101YM0800XNone listed

Mental Health Counselor: Definition to come...

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About NPI 1366957342

Roger Dale Jackson, MA's National Provider Identifier is 1366957342, issued on Dec 12, 2017. The primary taxonomy on file is Mental Health Counselor (101YM0800X), and the practice location is in Merrillville, IN. The record was last updated on Oct 11, 2018.