Mary Jackson, LCPC, LCAC, LPC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

2738 Issued in KS

Practice address

2148 Broadway Ste C5
Grand Junction, CO 81507-1098

Phone

(970) 230-3559

NPI assigned

Jul 29, 2015

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Opted out of Medicare

Yes, effective Mar 21, 2024 through Mar 21, 2028

Medicare enrollment (NPD)

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 and National Provider Directory roles.

• Professional Treatment Services

  • Community/Behavioral Health Agency
  • Lawrence, KS
  • NPI 1649716192
  NPD (past)
• Professional Treatment Services, LLC

  • Addiction (Substance Use Disorder) Counselor
  • Lawrence, KS
  • NPI 1710008461
  NPD (past)

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

{
    "created_epoch": "1438128000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1780444800000",
    "number": "1184009367",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2148 BROADWAY STE C5",
            "city": "GRAND JUNCTION",
            "state": "CO",
            "postal_code": "815071098",
            "telephone_number": "970-230-3559"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2148 BROADWAY STE C5",
            "city": "GRAND JUNCTION",
            "state": "CO",
            "postal_code": "815071098",
            "telephone_number": "970-230-3559"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "MARY",
        "credential": "LCPC, LCAC, LPC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2015-07-29",
        "last_updated": "2026-06-03",
        "certification_date": "2026-06-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "KS",
            "license": "2738",
            "primary": true
        },
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "KS",
            "license": "0730",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ryan Jackman, M.D.
• Elizabeth Dawn Jacks
• Sharon S. Jacksi, PH.D,
• Brett Taylor Jackson
• Kiana Nicole Jackson
• Whitney Jackson
• David Orlan Jacobson, DDS
• Debbie L Jacobson, RN
• Roger E Jacobson, M.D.
• Jacqueline'S Counseling Services LLC

• Professional Counselor in Grand Junction, CO
• Providers in Grand Junction, CO by specialty
• Professional Counselor in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 3, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.