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

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, LMFT

Title

Sole Member

Phone

(412) 213-8425

Specialties & licenses 1

Addresses

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": []
}

• Donald E Bywaters
• Bridgett Mae Byzek
• Kelly Byzek
• C & G Health Solutions LLC
• C & Li PA, Inc
• C. S. Reshmi, M.D. Inc.
• C.a. Flecker & Associates
• C.Charles Iannuzzi,M.D.,PC
• Leonard R Cabacungan, MD
• Tabitha Cabatino, LCSW

• 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.