Individual provider · Type 1 NPI
Shane Michell Jackson, LPC
Addiction (Substance Use Disorder) Counselor · Gilmer, TX
NPI number
1922173897
Active
Practice location
115 W Tyler St
Gilmer, TX 75644-2239
Fax (903) 843-4336
Mailing address
PO Box 1551
Gilmer, TX 75644-1551
Specialties and licenses
| Taxonomy | Code | License |
|---|---|---|
| Addiction (Substance Use Disorder) Counselor Primary | 101YA0400X | 4128 (TX) |
| Mental Health Counselor | 101YM0800X | 16480 (TX) |
Addiction (Substance Use Disorder) Counselor: Definition to come...
Other addiction (substance use disorder) counselor providers in Gilmer
About NPI 1922173897
Shane Michell Jackson, LPC's National Provider Identifier is 1922173897, issued on Nov 22, 2006. The primary taxonomy on file is Addiction (Substance Use Disorder) Counselor (101YA0400X), and the practice location is in Gilmer, TX. The record was last updated on Sep 11, 2025.