Thomas D Jackson

Primary specialty

Peer SpecialistTaxonomy code 175T00000X

Practice address

612 Woodland Square Loop SE Ste 401
Lacey, WA 98503-1070

Phone

(360) 763-5828

NPI assigned

Dec 7, 2021

Sex

Male

Sole proprietor

No

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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.

• Olympic Health and Recovery Services

  • Community/Behavioral Health Agency
  • Lacey, WA
  • NPI 1760007504
  NPD
• Thurston Mason Behavioral Health Organization

  • Community/Behavioral Health Agency
  • Lacey, WA
  • NPI 1265932198
  NPD (past)

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

{
    "created_epoch": "1638835200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1638835200000",
    "number": "1093473092",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "612 WOODLAND SQUARE LOOP SE STE 401",
            "city": "LACEY",
            "state": "WA",
            "postal_code": "985031070",
            "telephone_number": "360-763-5828"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "612 WOODLAND SQUARE LOOP SE STE 401",
            "city": "LACEY",
            "state": "WA",
            "postal_code": "985031070",
            "telephone_number": "360-763-5828"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "THOMAS",
        "middle_name": "D",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-12-07",
        "last_updated": "2021-12-07",
        "certification_date": "2021-12-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "175T00000X",
            "taxonomy_group": "",
            "desc": "Peer Specialist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Beatrice Irungu, RN, BSN
• Richelle Irving
• Olivia Ivy
• Nicole Danielle Jackson, MS, ATC, CSCS
• Renee Jackson
• Jordan Paige Jacobson
• Jennifer Jaeger, MA, MHP, CMHS, LMHC
• Emma Jallo
• Sarah James Pearse, LMHC, CDPT
• Jodi Charity James, DPT

• Peer Specialist in Lacey, WA
• Providers in Lacey, WA by specialty
• Peer Specialist in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 7, 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.

Verify at the official NPI Registry.