Active NPI
Julie Jackson
- Case Manager/Care Coordinator
- Mesa, AZ
National Provider Identifier
1164817599
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Case Manager/Care Coordinator
- License
- LMSW-14007
- Practice address
- 6915 E Main St
Mesa, AZ 85207-8229 - Phone
- (602) 806-2814
- Fax
- (480) 288-1332
- NPI assigned
- Apr 2, 2015
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Case Manager/Care Coordinator | 171M00000X | LMSW-14007 | AZ | Primary |
Addresses
Primary practice location
6915 E Main St
Mesa, AZ 85207-8229
Mailing address
202 E. Earll Dr.
Suite 200
Phoenix, AZ 85012-2647
Phone (602) 808-2800
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LMSW-14007 | AZ | MD | Case Manager/Care Coordinator |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Oakwood Creative Care Inc. | Past | Accepting new patients | |
| Lifewell Behavioral Wellness | 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 and National Provider Directory roles.
-
- Community/Behavioral Health Agency
- Mesa, AZ
- NPI 1720330194
-
- Adult Day Care Clinic/Center
- Mesa, AZ
- NPI 1114388626
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1427932800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1427932800000",
"number": "1164817599",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "202 E. EARLL DR.",
"address_2": "SUITE 200",
"city": "PHOENIX",
"state": "AZ",
"postal_code": "850122647",
"telephone_number": "602-808-2800",
"fax_number": "602-808-2716"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6915 E MAIN ST",
"city": "MESA",
"state": "AZ",
"postal_code": "852078229",
"telephone_number": "602-806-2814",
"fax_number": "480-288-1332"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "JULIE",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2015-04-02",
"last_updated": "2015-04-02",
"status": "A"
},
"taxonomies": [
{
"code": "171M00000X",
"taxonomy_group": "",
"desc": "Case Manager/Care Coordinator",
"state": "AZ",
"license": "LMSW-14007",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Mesa, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 2, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.