Steven Wayne Jackson, LPC – Professional Counselor

Key facts

NPI: 1063739746
Entity type: Individual (NPI type 1)
Primary specialty: Professional Counselor 101YP2500X
License: 1194 (WY)
Practice address: 1941 S 42ND St Ste 514
Omaha, NE 68105
Phone: (402) 614-8444
NPI assigned: Apr 21, 2010
Sex: Male
Sole proprietor: No

Organizations & group practices 1

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.

Capstone Behavioral Health, Inc. Mental Health Counselor · Omaha, NE · NPI 1154371748

NPD (past)

Medicare participation

Medicare fee-for-service enrollment: Not listed in the public Medicare enrollment file
Eligible to order & refer: Part B services: No · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No

National Provider Directory

Medicare enrollment (NPD): Yes

State licenses

License	State	Type	Specialty
1194	WY	MD	Clinical Social Worker

Practice roles

Organization	Specialty	Status	New patients
Capstone Behavioral Health, Inc.		Past since Aug 16, 2011	Accepting new patients

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
Counselor	101Y00000X
Professional Counselor	101YP2500X	1194	WY	Yes

Addresses

Primary practice location

1941 S 42ND St Ste 514
Omaha, NE 68105

Mailing address

401 S 23Rd St
Worland, WY 82401-3725
Phone (307) 347-6165

Other identifiers

Identifier	Type	State	Issuer
1194	Other	WY	MENTAL HEALTH PROFESSIONS LICENSING BOARD

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Jun 12, 2018.

{
    "created_epoch": "1271808000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1528761600000",
    "number": "1063739746",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "401 S 23RD ST",
            "city": "WORLAND",
            "state": "WY",
            "postal_code": "824013725",
            "telephone_number": "307-347-6165",
            "fax_number": "307-347-6166"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1941 S 42ND ST STE 514",
            "city": "OMAHA",
            "state": "NE",
            "postal_code": "68105",
            "telephone_number": "402-614-8444"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "STEVEN",
        "middle_name": "WAYNE",
        "credential": "LPC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-04-21",
        "last_updated": "2018-06-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "WY",
            "license": "1194",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MENTAL HEALTH PROFESSIONS LICENSING BOARD",
            "identifier": "1194",
            "state": "WY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Omaha, NE

All providers in Omaha, NE · Professional Counselor in Nebraska

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 12, 2018. Information in NPPES is self-reported and not verified by CMS.
NUCC Health Care Provider Taxonomy: specialty names.
Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
Order and Referring (CMS).
National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.