Illya Jackson

NPI #1700269149 in Ft Worth, Texas

Provider Information

NPI Number: 1700269149
Entity Type: Individual
Name: Illya Jackson
Gender: Not Specified
Sole Proprietor: Yes
Primary Specialty: Marriage & Family Therapist
Enumeration Date: Jul 2, 2015
Last Updated: Jul 2, 2015

Practice Location

Address: 1518 VAUGHN BLVD
City: Ft Worth
State: Texas
ZIP Code: 76105-2307
Phone: (214) 515-2079

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Marriage & Family Therapist	106H00000X	Primary

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