Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Illya Jackson

Individual provider Marriage & Family Therapist · NPI 1700269149

Illya Jackson is a Marriage & Family Therapist in Ft Worth, Texas. Practices as a sole proprietor. Licensed in California.

Licensed in
CA
In the registry since
2015
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Practice location Address checks out

1518 Vaughn Blvd
Ft Worth, TX 76105-2307
Phone: (214) 515-2079
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Marriage & Family Therapist (primary) Taxonomy 106H00000X · Licence IACCP0064 (CA)

Record details

NPI number1700269149
Entity typeIndividual (Type 1)
GenderMale
Sole proprietorYes
NPI enumeratedJuly 2, 2015
Last updated in NPPESJuly 2, 2015

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