Active NPI
Lisa Kathryn Jackson, LPCC
- Professional Counselor
- Albuquerque, NM
National Provider Identifier
1063548709
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 0124141
- Practice address
- 3025 Florida St NE
Albuquerque, NM 87110-2614 - Phone
- (505) 417-6744
- NPI assigned
- Feb 26, 2007
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | 0124141 | NM | Primary |
Addresses
Primary practice location
3025 Florida St NE
Albuquerque, NM 87110-2614
Mailing address
4312 Carlisle Blvd NE
Albuquerque, NM 87107-4811
Phone (505) 323-3785
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 |
|---|---|---|---|
| 0124141 | NM | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1172448000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1611187200000",
"number": "1063548709",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4312 CARLISLE BLVD NE",
"city": "ALBUQUERQUE",
"state": "NM",
"postal_code": "871074811",
"telephone_number": "505-323-3785"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3025 FLORIDA ST NE",
"city": "ALBUQUERQUE",
"state": "NM",
"postal_code": "871102614",
"telephone_number": "505-417-6744"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "LISA",
"middle_name": "KATHRYN",
"credential": "LPCC",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-02-26",
"last_updated": "2021-01-21",
"certification_date": "2021-01-21",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "NM",
"license": "0124141",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Albuquerque, NM
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 21, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.