Jackson, Glenn

Jackson, Glenn is an individual health care provider with primary practice located at 504 Micah Dr Drawer M, Olney IL 62450-4720. He recently has 2 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder), Behavioral Health & Social Service Providers / Mental Health. Behavioral Health & Social Service Providers / Mental Health is his primary health care specialty. Jackson, Glenn can be contacted via phone (618) 395-4309.

Contact Information

Primary practice address
504 Micah Dr Drawer M Olney IL 62450-4720
Phone: (618) 395-4309
Fax: (618) 395-4507
Website:
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Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder) 101YA0400X
Behavioral Health & Social Service Providers / Mental Health 101YM0800X

Profile Details

NPI number 1568833283
LBN Legal business name Jackson, Glenn
Credentials LSW, LCPC, CMH
Entity Individual
Sole proprietor 1 No
Enumeration date Oct 8th, 2015
Last updated Oct 8th, 2015 - about 11 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1568833283 NPPES
Illinois Other 180.000994 LICENSED CLINICAL PROFESSIONAL COUNSELOR

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