Tierra Jackson, LPCA, LMFTA, RMFTI

Primary specialty

Marriage & Family TherapistTaxonomy code 106H00000X

License

IMT2200 Issued in FL

Practice address

4680 Lipscomb St NE
Suite 10a
Palm Bay, FL 32905-2984

Phone

(321) 433-3570

NPI assigned

May 21, 2014

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 3

Addresses

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": "1400630400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1418774400000",
    "number": "1225440548",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "910 UTE TRL",
            "city": "PATRICK AFB",
            "state": "FL",
            "postal_code": "329253160",
            "telephone_number": "828-994-7718"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4680 LIPSCOMB ST NE",
            "address_2": "SUITE 10A",
            "city": "PALM BAY",
            "state": "FL",
            "postal_code": "329052984",
            "telephone_number": "321-433-3570"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "TIERRA",
        "name_prefix": "Mrs.",
        "credential": "LPCA, LMFTA, RMFTI",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2014-05-21",
        "last_updated": "2014-12-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "FL",
            "license": "IMT2200",
            "primary": true
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "NC",
            "license": "9096A",
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "NC",
            "license": "A10704",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jacked DMD, PLLC
• Jackies Retirement LLC
• Keith Jackman
• Kelley Anne Jackson, M.A. CCC-SLP
• Monica D Jackson, PA
• Lakenya Jacobs
• James Jacobson, M.D.
• Martin Jacobson, D.C.
• Justin Jadunandan, DPT, ATC
• Jai Ho LLC

• Marriage & Family Therapist in Palm Bay, FL
• Providers in Palm Bay, FL by specialty
• Marriage & Family Therapist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 17, 2014; 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.