Kristina Jackson, LPCC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

CC01611 Issued in MN

Practice address

762 Transfer Rd Ste 21
Saint Paul, MN 55114-1489

Phone

(763) 789-4895

Fax

(763) 789-4798

NPI assigned

Jul 26, 2018

Last updated

Mar 27, 2019By the provider in NPPES

Sex

Female

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

Enrolled in MN

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Mental Health Counselor

Education

Other, 1997

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Mental Health Resources, IncGroup PAC ID 0446144992, 7 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

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.

• Mental Health Resources, Inc.

  • Community/Behavioral Health Agency
  • Minneapolis, MN
  • NPI 1821276049

  Multi-Specialty

  Medicare reassignment Care Compare group NPD
• Expanse - a Minnesota Mental Health Ketamine & Psychedelic Psychother

  dba Expanse MN

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Minneapolis, MN
  • NPI 1528726775

  Multi-Specialty

  Medicare reassignment NPD
• Mental Health Resources, Inc.

  • Community/Behavioral Health Agency
  • Saint Paul, MN
  • NPI 1790909703
  NPD

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

{
    "created_epoch": "1532563200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1553644800000",
    "number": "1235616863",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3606 55TH AVE N",
            "city": "BROOKLYN CENTER",
            "state": "MN",
            "postal_code": "554293310",
            "telephone_number": "612-599-5471"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "762 TRANSFER RD STE 21",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "551141489",
            "telephone_number": "763-789-4895",
            "fax_number": "763-789-4798"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "KRISTINA",
        "credential": "LPCC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-07-26",
        "last_updated": "2019-03-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "MN",
            "license": "CC01611",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Donanita Jackson
• Elizabeth Katner Jackson
• Jamie M Jackson, LPCC
• Kassidy Jackson
• Kathleen Adele Jackson, AG-ACNP
• Leah Jackson
• Melissa Jackson, RN
• Paige Taylor Aubriana Jackson, RN
• Steven Bruce Jackson, D.C, D.A.B.C.O
• Annette L Jacob, LICSW

• Professional Counselor in Saint Paul, MN
• Providers in Saint Paul, MN by specialty
• Professional Counselor in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 27, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.