Linda Natasha Rene Jackson, LPC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

3118 Issued in MS

Practice address

2715 Bullis Ave
Gulfport, MS 39501-5233

Phone

(228) 220-4226

NPI assigned

Mar 28, 2018

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MS

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Mental Health Counselor

Education

Other, 2018

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Premier Professional Counseling Services, LLCGroup PAC ID 7214329358, 6 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Premier Professional Counseling Services, LLC

  • Clinical Social Worker
  • Gulfport, MS
  • NPI 1750878781
  Medicare reassignment Care Compare group NPD
• Kimila Deflanders LCSW LLC

  • Clinical Social Worker
  • Gulfport, MS
  • NPI 1588217699
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1522195200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1721606400000",
    "number": "1053816314",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2715 BULLIS AVE",
            "city": "GULFPORT",
            "state": "MS",
            "postal_code": "395015233",
            "telephone_number": "706-845-4054",
            "fax_number": "228-220-4226"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2715 BULLIS AVE",
            "city": "GULFPORT",
            "state": "MS",
            "postal_code": "395015233",
            "telephone_number": "228-220-4226"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "LINDA",
        "middle_name": "NATASHA RENE",
        "credential": "LPC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-03-28",
        "last_updated": "2024-07-22",
        "certification_date": "2024-07-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "MS",
            "license": "3118",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Avery Jackson, APRN, FNP-C
• Christopher E Jackson
• Gary Dean Jackson, R.PH.
• Janice L. Jackson
• Jennifer Jackson, NP
• Lucia Jackson, LOT, CHT
• Melissa M Jackson, LCSW
• Monifa Chyenn Jackson, HNT/SNT
• Shavoka L Jackson
• Shaynell Jackson

• Mental Health Counselor in Gulfport, MS
• Providers in Gulfport, MS by specialty
• Mental Health Counselor in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 22, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.