Provider Demographics
NPI:1053022582
Name:JACKSON, EVA CARDENAS
Entity type:Individual
Prefix:
First Name:EVA
Middle Name:CARDENAS
Last Name:JACKSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:BEHAVIOR FRONTIERS LLC
Mailing Address - Street 2:1413 GABLES CT
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75075
Mailing Address - Country:US
Mailing Address - Phone:972-655-7275
Mailing Address - Fax:855-568-2494
Practice Address - Street 1:BEHAVIOR FRONTIERS LLC
Practice Address - Street 2:1413 GABLES CT
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75075
Practice Address - Country:US
Practice Address - Phone:972-655-7275
Practice Address - Fax:855-568-2494
Is Sole Proprietor?:No
Enumeration Date:2022-12-06
Last Update Date:2022-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician