Most Relevant Information
Provider Data
| NPI Number: | 1003597071 |
| Provider Name: | PHILIP JACKSON |
| Entity Type: | Individual |
| Taxonomy Code: | 101YA0400X |
| Specialty: | Counselor |
| License Number: |
Most Important Dates
| Enumeration Date: | 07/31/2023 |
| Last Updated: | 07/31/2023 |
Provider Practice Location
360 S WESTLAKE AVE
LOS ANGELES
CA
900572906
Practice Location Phone/Fax
| Phone: | 2134839201 |
| Fax: |
Provider Mailing Location
360 S WESTLAKE AVE
LOS ANGELES
CA
900572906
Provider Mailing Phone/Fax
| Phone: | 2134839201 |
| Fax: |