Active NPI
Shetocquia Jackson
- Mental Health Counselor
- Houston, TX
National Provider Identifier
1023589439
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- 93452
- Practice address
- 7676 Hillmont St Ste 310G
Houston, TX 77040-6483 - Phone
- (832) 953-5482
- NPI assigned
- Dec 10, 2018
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | 93452 | TX | Primary |
Addresses
Primary practice location
7676 Hillmont St Ste 310G
Houston, TX 77040-6483
Mailing address
7676 Hillmont St Ste 310G
Houston, TX 77040-6483
Phone (832) 953-5482
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 |
|---|---|---|---|
| 93452 | TX | MD | Mental Health Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Dream Workshop LLC | Mental Health | Current | Accepting new patients |
| The Foundation Builders | Current | Accepting new patients |
Locations
7676 Hillmont St
Ste 310G
Houston, TX 77040
Phone (832) 953-5482
Organizations & group practices 2
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.
-
dba Tackle Ur Dreams
- Community/Behavioral Health Agency
- Houston, TX
- NPI 1659927457
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1544400000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1712361600000",
"number": "1023589439",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7676 HILLMONT ST STE 310G",
"city": "HOUSTON",
"state": "TX",
"postal_code": "770406483",
"telephone_number": "832-953-5482"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "7676 HILLMONT ST STE 310G",
"city": "HOUSTON",
"state": "TX",
"postal_code": "770406483",
"telephone_number": "832-953-5482"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "SHETOCQUIA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2018-12-10",
"last_updated": "2024-04-06",
"certification_date": "2024-04-06",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "TX",
"license": "93452",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Houston, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 6, 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.