Active NPI
Adayis Marshay Jackson Sr., L.C.D.C
- Addiction (Substance Use Disorder) Counselor
- Austin, TX
National Provider Identifier
1003264086
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Addiction (Substance Use Disorder) Counselor
- License
- 12026
- Practice address
- 8711 Burnet Rd Ste. a-3
Austin, TX 78757-7043 - Phone
- (512) 257-0066
- Fax
- (512) 459-0499
- NPI assigned
- May 31, 2016
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | 12026 | TX | Primary |
Addresses
Primary practice location
8711 Burnet Rd Ste. a-3
Austin, TX 78757-7043
Mailing address
8711 Burnet Rd Ste. a-3
Austin, TX 78757
Phone (512) 257-0066
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 12026 | TX | MD | Professional Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Changes Counseling Services | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Substance Abuse Rehabilitation Facility
- Austin, TX
- NPI 1083816086
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1464652800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1464652800000",
"number": "1003264086",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "8711 BURNET RD STE. A-3",
"city": "AUSTIN",
"state": "TX",
"postal_code": "78757",
"telephone_number": "512-257-0066",
"fax_number": "512-459-0499"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "8711 BURNET RD STE. A-3",
"city": "AUSTIN",
"state": "TX",
"postal_code": "787577043",
"telephone_number": "512-257-0066",
"fax_number": "512-459-0499"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "ADAYIS",
"middle_name": "MARSHAY",
"name_prefix": "Mr.",
"name_suffix": "Sr.",
"credential": "L.C.D.C",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2016-05-31",
"last_updated": "2016-05-31",
"status": "A"
},
"taxonomies": [
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": "TX",
"license": "12026",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Austin, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 31, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.