Data from the NPPES registry. May not reflect recent changes — verify at nppes.cms.hhs.gov.
WILLIE JACKSON
Active Sole ProprietorIntellectual Disabilities Residential Treatment Facility · MESA, AZ
Registration Details
- NPI Number
- 1144061649
- Provider Type
- Individual
- Gender
- Male
- NPI Issued
- Jun 6, 2024 (1.8758405381003 yrs)
- Last Updated
- Jan 30, 2026
- License
-
23683875 (AZ)
- Sole Proprietor
- Yes
Practice Information
- Address
-
400 N PIMAMESA, AZ, 852015907Browse AZ providers · Browse ZIP 85201
- Phone
- 6025510659
- Primary Specialty
-
Intellectual Disabilities Residential Treatment Facility
320600000X
- Additional Specialty
- Intellectual Disabilities Residential Treatment Facility
- Additional Specialty
- Behavior Technician
Other Intellectual Disabilities Residential Treatment Facility Providers in MESA, AZ
| Name | Credential | NPI |
|---|---|---|
| THOMAS ROBERT FELS | — | 1326713876 |
| JENNIFER BRIDGERS | — | 1942192224 |
Data sourced from the NPPES National Provider Identifier registry. This information is for informational purposes only and is not a substitute for verifying credentials with the appropriate licensing authority. For official verification, use the NPPES NPI Registry or the relevant state medical board.