Active NPI
Shanta D Jackson
- Professional Counselor
- Cedar Hill, TX
National Provider Identifier
1003322827
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 73107
- Practice address
- 445 E FM 1382 Ste 3
Cedar Hill, TX 75104-6046 - Phone
- (214) 699-7908
- NPI assigned
- Dec 15, 2017
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | 73107 | TX | |
| Professional Counselor | 101YP2500X | 73107 | TX | Primary |
Addresses
Primary practice location
445 E FM 1382 Ste 3
Cedar Hill, TX 75104-6046
Mailing address
445 E FM 1382 Ste 3
Cedar Hill, TX 75104-6046
Phone (972) 523-1996
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 |
|---|---|---|---|
| 73107 | TX | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1513296000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1724112000000",
"number": "1003322827",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "445 E FM 1382 STE 3",
"city": "CEDAR HILL",
"state": "TX",
"postal_code": "751046046",
"telephone_number": "972-523-1996"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "445 E FM 1382 STE 3",
"city": "CEDAR HILL",
"state": "TX",
"postal_code": "751046046",
"telephone_number": "214-699-7908"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "SHANTA",
"middle_name": "D",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2017-12-15",
"last_updated": "2024-08-20",
"certification_date": "2024-08-20",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "TX",
"license": "73107",
"primary": false
},
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "TX",
"license": "73107",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Cedar Hill, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 20, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.