Tony Jackson, LPT

Primary specialty

Licensed Psychiatric TechnicianTaxonomy code 167G00000X

License

36316 Issued in CA

Practice address

300 E 15TH St
Merced, CA 95341-6217

Phone

(209) 381-6879

Fax

(209) 725-3775

NPI assigned

Apr 7, 2015

Last updated

Apr 7, 2015By the provider in NPPES

Sex

Male

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

State licenses

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

{
    "created_epoch": "1428364800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1428364800000",
    "number": "1225424211",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2084",
            "city": "MERCED",
            "state": "CA",
            "postal_code": "953440084",
            "telephone_number": "209-381-6879",
            "fax_number": "209-725-3775"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 E 15TH ST",
            "city": "MERCED",
            "state": "CA",
            "postal_code": "953416217",
            "telephone_number": "209-381-6879",
            "fax_number": "209-725-3775"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "TONY",
        "credential": "LPT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-04-07",
        "last_updated": "2015-04-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "167G00000X",
            "taxonomy_group": "",
            "desc": "Licensed Psychiatric Technician",
            "state": "CA",
            "license": "36316",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1013030808",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Andrew Jabson
• Veronica Jacinto
• Demtrais Jackson
• Jarvis Jackson
• Monica Jackson
• Raquel C Jacobo
• Lisa Jacobs
• Jacobson Dental Corp (Children's Choice Dental Care)
• Lisa Louise Jacquez
• Priyanka Jain, MD

• Licensed Psychiatric Technician in Merced, CA
• Providers in Merced, CA by specialty
• Licensed Psychiatric Technician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 7, 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.

Verify at the official NPI Registry.