Judy Michelle Jacobs, MLSW CCTP1

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

9822-M Issued in AR

Practice address

103 Bullard
Manila, AR 72442-8216

Phone

(870) 484-0572

NPI assigned

Feb 13, 2020

Last updated

Feb 13, 2020By the provider in NPPES

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 AR, MO2 enrollments

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 2

Specialty

Clinical Social Worker

Education

Other, 2019

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Hope and Healing of Nea PLLCGroup PAC ID 7012302300, 8 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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Hope & Healing of Nea PLLC

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Jonesboro, AR
  • NPI 1881299675

  Clinical

  Medicare reassignment Care Compare group NPD
• Family Counseling Center, Inc.

  • Community/Behavioral Health Agency
  • Kennett, MO
  • NPI 1669477550
  Medicare reassignment NPD
• Family Counseling Center, Inc.

  dba FCC Primary Care

  • Primary Care Clinic/Center
  • Poplar Bluff, MO
  • NPI 1235738493
  NPD
• Vital Balance Health and Wellness PLLC

  • Family Nurse Practitioner
  • Jonesboro, AR
  • NPI 1265343578
  NPD (past)

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

{
    "created_epoch": "1581552000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1581552000000",
    "number": "1063045458",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "103 BULLARD",
            "city": "MANILA",
            "state": "AR",
            "postal_code": "724428216",
            "telephone_number": "870-484-0572",
            "fax_number": "870-486-2826"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "103 BULLARD",
            "city": "MANILA",
            "state": "AR",
            "postal_code": "724428216",
            "telephone_number": "870-484-0572"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACOBS",
        "first_name": "JUDY",
        "middle_name": "MICHELLE",
        "name_prefix": "Ms.",
        "credential": "MLSW CCTP1",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-02-13",
        "last_updated": "2020-02-13",
        "certification_date": "2020-02-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "AR",
            "license": "9822-M",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Anna Geneva Jackson, QBHP
• Jeremy A Jackson, PHARMD
• Matthew Jackson, PD
• Whitney E Jackson, MCD, CF-SLP
• Jackson's Pharmacy
• Landra Kay Jeffers
• Cheyenne A Johnson, QBHP
• Ka Legacy Inc (Legacy Online Counseling and Consulting LLC)
• Brenda A Kennedy, APN
• Z'Kiah Kuykendall, LAC

• Clinical Social Worker in Manila, AR
• Providers in Manila, AR by specialty
• Clinical Social Worker in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 13, 2020; 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.