Active NPI
Tim Jackson
- Addiction (Substance Use Disorder) Counselor
- Garland, TX
National Provider Identifier
1215662200
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Addiction (Substance Use Disorder) Counselor
- License
- 13134
- Practice address
- 2402 High Star Dr
Garland, TX 75041-3236 - Phone
- (214) 253-7309
- NPI assigned
- Jul 22, 2022
- Last updated
- Jul 22, 2022
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | 13134 | TX | Primary |
Addresses
Primary practice location
2402 High Star Dr
Garland, TX 75041-3236
Mailing address
2402 High Star Dr
Garland, TX 75041-3236
Phone (214) 253-7309
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | tjackson@ntbha.org |
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 |
|---|---|---|---|
| 13134 | TX | MD | Addiction (Substance Use Disorder) Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1658448000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1658448000000",
"number": "1215662200",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2402 HIGH STAR DR",
"city": "GARLAND",
"state": "TX",
"postal_code": "750413236",
"telephone_number": "214-253-7309"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2402 HIGH STAR DR",
"city": "GARLAND",
"state": "TX",
"postal_code": "750413236",
"telephone_number": "214-253-7309"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "TIM",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2022-07-22",
"last_updated": "2022-07-22",
"certification_date": "2022-07-22",
"status": "A"
},
"taxonomies": [
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": "TX",
"license": "13134",
"primary": true
}
],
"identifiers": [],
"endpoints": [
{
"endpointType": "DIRECT",
"endpointTypeDescription": "Direct Messaging Address",
"endpoint": "tjackson@ntbha.org",
"affiliation": "N",
"endpointDescription": "business email",
"address_1": "2402 High Star Dr",
"city": "Garland",
"state": "TX",
"country_code": "US",
"postal_code": "750413236",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Garland, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 22, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.