Candis L Jackson, LMHC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

MH4441 Issued in FL

Practice address

4161 Tamiami TRL Ste 304D
Port Charlotte, FL 33952-9254

Phone

(941) 625-5895

Fax

(941) 625-1047

NPI assigned

Feb 6, 2008

Sex

Female

Sole proprietor

No

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

Enrolled in FL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Mental Health Counselor

Education

Other, 1972

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Bennett W McAllister MD PAGroup PAC ID 3678617347, 8 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

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.

• Bennett W McAllister MD PA

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Port Charlotte, FL
  • NPI 1104154053
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1202256000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1715040000000",
    "number": "1104004746",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 512139",
            "city": "PUNTA GORDA",
            "state": "FL",
            "postal_code": "339512139",
            "telephone_number": "941-625-5895",
            "fax_number": "941-625-1047"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4161 TAMIAMI TRL STE 304D",
            "city": "PORT CHARLOTTE",
            "state": "FL",
            "postal_code": "339529254",
            "telephone_number": "941-625-5895",
            "fax_number": "941-625-1047"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "CANDIS",
        "middle_name": "L",
        "name_prefix": "Ms.",
        "credential": "LMHC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-02-06",
        "last_updated": "2024-05-07",
        "certification_date": "2024-05-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "FL",
            "license": "MH4441",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "116480500",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Yaidelin Izquierdo Concepcion
• Ashlee Jackimowicz
• Marcy Jackovic
• Jackson Optical LLC
• Jackson Transportation
• Julliet Jackson
• Richard E Jackson, PA-C
• Cynthia Darlene Jacobs, ARNP
• Karin L Jacobs
• Marianne Bernadette Jacobs, D.O.

• Mental Health Counselor in Port Charlotte, FL
• Providers in Port Charlotte, FL by specialty
• Mental Health Counselor in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 7, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.