Chandra Alisa Jackson, MHP

Primary specialty

Case Manager/Care CoordinatorTaxonomy code 171M00000X

Practice address

1058 E Worthy St Ste B-2
Gonzales, LA 70737-4302

Phone

(225) 450-3216

Fax

(225) 450-3799

NPI assigned

Nov 2, 2017

Last updated

Sep 23, 2019By the provider in NPPES

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Practice roles

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.

• Enhance Health Care Services Behavioral Health, LLC

  • Community/Behavioral Health Agency
  • Gonzales, LA
  • NPI 1366981557
  NPD (past)

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

{
    "created_epoch": "1509580800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1569196800000",
    "number": "1164934998",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1058 E WORTHY ST STE B-2",
            "city": "GONZALES",
            "state": "LA",
            "postal_code": "707374302",
            "telephone_number": "225-450-3216",
            "fax_number": "225-450-3799"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1058 E WORTHY ST STE B-2",
            "city": "GONZALES",
            "state": "LA",
            "postal_code": "707374302",
            "telephone_number": "225-450-3216",
            "fax_number": "225-450-3799"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "CHANDRA",
        "middle_name": "ALISA",
        "name_prefix": "Ms.",
        "credential": "MHP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-11-02",
        "last_updated": "2019-09-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "171M00000X",
            "taxonomy_group": "",
            "desc": "Case Manager/Care Coordinator",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1366981557",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Island Enterprises, Inc.
• Island Enterprises, Inc.
• Island Enterprises, Inc.
• Janis Kaye Ivey, LCSW
• Candelaria M Jackson
• Lauren Ashley Jackson
• Taye-Rafael Jackson
• Vanessa Jacobs, BA
• Shanda James, LPC-S, NCC, BC-TMH
• Jannaiah C. Tripuraneni MD LLC

• Case Manager/Care Coordinator in Gonzales, LA
• Providers in Gonzales, LA by specialty
• Case Manager/Care Coordinator in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 23, 2019; 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.