National Provider Identifier Database

C WESLEY JACKSON JR PHD INC
Clinical

A psychologist who provides continuing and comprehensive mental and behavioral health care for individuals and families; consultation to agencies and communities; training, education and supervision; and research-based practice. It is a specialty in breadth — one that is broadly inclusive of severe psychopathology — and marked by comprehensiveness and integration of knowledge and skill from a broad array of disciplines within and outside of psychology proper. The scope of clinical psychology encompasses all ages, multiple diversities and varied systems.


Contact Information

C WESLEY JACKSON JR PHD INC
2980 WASHINGTON BLVD
CLEVELAND HEIGHTS, OH44118-2450
Phone: 216-321-9355
Fax: 216-932-3341
Website:
Specialty Taxonomy Code
* Clinical 103TC0700X

* Indicates primary specialty

NPI Profile & details for C WESLEY JACKSON JR PHD INC

NPI Number 1720202500
Legal business name
LBN
C WESLEY JACKSON JR PHD INC
Authorized official C JACKSON - (PRESIDENT OWNER)
Entity Organization
Organization subpart No
Enumeration date 04/12/2007
Last updated 07/30/2012 - About 14 years ago
Sole proprietor1 Not specified
Identifiers
  • MI License #: 000519
  • OH License #: 474
  • OH Medicaid: 0253309

1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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