Sophia Jackson, AMFT

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

129136 Issued in CA

Practice address

3950 Long Beach Blvd Ste 101
Long Beach, CA 90807-5410

Phone

(562) 684-1300

NPI assigned

Aug 30, 2022

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

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not 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.

• Psych Lab Psychology, Inc.

  dba Psych Lab

  • Clinical Psychologist
  • Long Beach, CA
  • NPI 1811452196
  NPD

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

{
    "created_epoch": "1661817600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1661817600000",
    "number": "1073233037",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3950 LONG BEACH BLVD STE 101",
            "city": "LONG BEACH",
            "state": "CA",
            "postal_code": "908075410"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3950 LONG BEACH BLVD STE 101",
            "city": "LONG BEACH",
            "state": "CA",
            "postal_code": "908075410",
            "telephone_number": "562-684-1300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "SOPHIA",
        "credential": "AMFT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-08-30",
        "last_updated": "2022-08-30",
        "certification_date": "2022-08-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "CA",
            "license": "129136",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OTHER INSURANCES",
            "identifier": "129136",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Megin O Jackson, MSW INTERN
• Michael Deangelo Jackson, NURSE PRACTITIONER
• Patrice Little Jackson
• Rozalie Vonszelda Jackson, MD
• Shutera Jackson
• Stanford Jackson, CATCII
• Terrell Jackson
• Tiffany Jackson
• Tommy Jackson
• Veronica L Jackson

• Mental Health Counselor in Long Beach, CA
• Providers in Long Beach, CA by specialty
• Mental Health Counselor in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 30, 2022; 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.