C Michaela Jacks LLC

Primary specialty

Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X

License

MF000999 Issued in PA

Legal business name

C MICHAELA JACKS LLC

Practice address

1789 S Braddock Ave Ste 350
Pittsburgh, PA 15218-1871

Phone

(412) 213-8425

NPI assigned

Apr 25, 2018

Last updated

May 1, 2018By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Crystal M Jacks, LMFTNPI 1285131870

Title

Sole Member

Phone

(412) 213-8425

Specialties & licenses 1

Addresses

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Crystal Michaela Jacks, LMFT

  • Marriage & Family Therapist
  • Pittsburgh, PA
  • NPI 1285131870
  Authorized official Same address or phone

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

{
    "created_epoch": "1524614400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1525132800000",
    "number": "1144718172",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1789 S BRADDOCK AVE STE 350",
            "city": "PITTSBURGH",
            "state": "PA",
            "postal_code": "152181871",
            "telephone_number": "412-213-8425"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1789 S BRADDOCK AVE STE 350",
            "city": "PITTSBURGH",
            "state": "PA",
            "postal_code": "152181871",
            "telephone_number": "412-213-8425"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "C MICHAELA JACKS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-04-25",
        "last_updated": "2018-05-01",
        "status": "A",
        "authorized_official_last_name": "JACKS",
        "authorized_official_first_name": "CRYSTAL",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "SOLE MEMBER",
        "authorized_official_telephone_number": "412-213-8425",
        "authorized_official_credential": "LMFT"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": "PA",
            "license": "MF000999",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Mental Health Clinic/Center (Including Community Mental Health Center) in Pittsburgh, PA
• Providers in Pittsburgh, PA by specialty
• Mental Health Clinic/Center (Including Community Mental Health Center) in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 1, 2018; 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.