Byron Jackson

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

Practice address

3101 N Central Ave # 220B
Phoenix, AZ 85012-2645

Phone

(602) 920-2791

NPI assigned

Apr 2, 2020

Last updated

Apr 2, 2020By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Practice roles

Locations

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.

• Jacksons Youth and Family Service

  • Community/Behavioral Health Agency
  • Phoenix, AZ
  • NPI 1467062539
  NPD Authorized official

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

{
    "created_epoch": "1585785600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1585785600000",
    "number": "1225667264",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2320 E BASELINE RD STE 148-203",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850426959",
            "telephone_number": "602-920-2791"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3101 N CENTRAL AVE # 220B",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850122645",
            "telephone_number": "602-920-2791"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "BYRON",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2020-04-02",
        "last_updated": "2020-04-02",
        "certification_date": "2020-04-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "AZ",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tana Jackson-Wilson
• Anthony Rashad Jackson, PA
• Azel Jackson, LPC
• Beverly Yvonne Jackson, RN, MSN
• Brock Jackson, MD
• Cate Jackson, DNP, PMHNP-BC
• Cherie Jackson
• Dakahri Jackson
• Darlene Jackson
• Darlene Victoria Jackson, OTR/L

• Community/Behavioral Health Agency in Phoenix, AZ
• Providers in Phoenix, AZ by specialty
• Community/Behavioral Health Agency in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 2, 2020; 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.