Data from the NPPES registry. May not reflect recent changes — verify at nppes.cms.hhs.gov.
MELVIN JACKSON
Active Sole ProprietorMELVIN JACKSON is a Residential Treatment, Emotionally Disturbed Children healthcare provider located in AVONDALE, Arizona. NPI 1831336411 is currently active in the NPPES registry. Verify at CMS.
Residential Treatment, Emotionally Disturbed Children · AVONDALE, AZ
Registration Details
- NPI Number
- 1831336411
- Provider Type
- Individual
- Gender
- Male
- NPI Issued
- Jan 19, 2009 (17.611515253153 yrs)
- Last Updated
- Jan 19, 2009
- License
-
11297 (AZ)
- Sole Proprietor
- Yes
Practice Information
- Address
-
2415 N 124TH CIRAVONDALE, AZ, 853926509Browse AZ providers · Browse ZIP 85392
- Phone
- 6028413438
- Primary Specialty
-
Residential Treatment, Emotionally Disturbed Children
322D00000X
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.