Active NPI
Jacquelyn Jackson
- Counselor
- Baton Rouge, LA
National Provider Identifier
1114451721
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Counselor
- Practice address
- 3040 Teddy Drive
Baton Rouge, LA 70809 - Phone
- (225) 218-4444
- NPI assigned
- Apr 20, 2017
- Last updated
- Jun 30, 2021
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Counselor | 101Y00000X | NU | Primary | |
| Case Manager/Care Coordinator | 171M00000X | LA | ||
| Behavior Technician | 106S00000X | LA |
Addresses
Primary practice location
3040 Teddy Drive
Baton Rouge, LA 70809
Mailing address
3040 Teddy Drive
Baton Rouge, LA 70809
Phone (225) 218-4444
Other practice location 1
1701 White St
McComb, MS 39648-2711
Phone (601) 249-4217
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
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| SW Ms Mental Health Mental Retardation Commission | Past | Accepting new patients | |
| Southwest Mississippi Mental Health Mental Retardation Commission | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
dba SW Ms Mental Health Region XI
- Social Worker
- McComb, MS
- NPI 1366694820
-
- Mental Health Clinic/Center (Including Community Mental Health Center)
- McComb, MS
- NPI 1184662694
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1492646400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1625011200000",
"number": "1114451721",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3040 TEDDY DRIVE",
"city": "BATON ROUGE",
"state": "LA",
"postal_code": "70809",
"telephone_number": "225-218-4444"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3040 TEDDY DRIVE",
"city": "BATON ROUGE",
"state": "LA",
"postal_code": "70809",
"telephone_number": "225-218-4444"
}
],
"practiceLocations": [
{
"address_1": "1701 White St",
"address_purpose": "LOCATION",
"city": "McComb",
"state": "MS",
"postal_code": "396482711",
"country_code": "US",
"telephone_number": "601-249-4217",
"fax_number": "601-249-4234",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "JACKSON",
"first_name": "JACQUELYN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2017-04-20",
"last_updated": "2021-06-30",
"certification_date": "2021-06-30",
"status": "A"
},
"taxonomies": [
{
"code": "101Y00000X",
"taxonomy_group": "",
"desc": "Counselor",
"state": "NU",
"license": null,
"primary": true
},
{
"code": "171M00000X",
"taxonomy_group": "",
"desc": "Case Manager/Care Coordinator",
"state": "LA",
"license": null,
"primary": false
},
{
"code": "106S00000X",
"taxonomy_group": "",
"desc": "Behavior Technician",
"state": "LA",
"license": null,
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Baton Rouge, LA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 30, 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.