Provider Demographics
NPI:1881205185
Name:JACKSON-MAPPUS, TEAL SABIAN DONESE (LCSW)
Entity type:Individual
Prefix:
First Name:TEAL
Middle Name:SABIAN DONESE
Last Name:JACKSON-MAPPUS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 WOODWARD ST APT 206
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78704-7284
Mailing Address - Country:US
Mailing Address - Phone:512-791-0710
Mailing Address - Fax:
Practice Address - Street 1:1500 W 38TH ST STE 32
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78731-6318
Practice Address - Country:US
Practice Address - Phone:877-750-3566
Practice Address - Fax:888-356-8766
Is Sole Proprietor?:No
Enumeration Date:2020-08-11
Last Update Date:2024-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1063741041C0700X
101Y00000X, 390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program