Jackson Behavioral Health Services LLC

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

Legal business name

JACKSON BEHAVIORAL HEALTH SERVICES LLC

Practice address

4137 Sauk TRL Ste 146
Richton Park, IL 60471-1253

Phone

(708) 983-8074

NPI assigned

Feb 25, 2020

Last updated

Feb 25, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Addison Jackson Jr., LCSWNPI 1821648668

Title

Director

Phone

(708) 983-8074

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Addison Jackson Jr., LCSW

  • Clinical Social Worker
  • Richton Park, IL
  • NPI 1821648668
  Authorized official Same address or phone

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

{
    "created_epoch": "1582588800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1582588800000",
    "number": "1063046498",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4137 SAUK TRL STE 146",
            "city": "RICHTON PARK",
            "state": "IL",
            "postal_code": "604711253"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4137 SAUK TRL STE 146",
            "city": "RICHTON PARK",
            "state": "IL",
            "postal_code": "604711253",
            "telephone_number": "708-983-8074"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JACKSON BEHAVIORAL HEALTH SERVICES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-02-25",
        "last_updated": "2020-02-25",
        "certification_date": "2020-02-25",
        "status": "A",
        "authorized_official_last_name": "JACKSON",
        "authorized_official_first_name": "ADDISON",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "708-983-8074",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Clinical Social Worker in Richton Park, IL
• Providers in Richton Park, IL by specialty
• Clinical Social Worker in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 25, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.