Crystal A. Jackson, PH.D., LLP

Primary specialty

Counseling PsychologistTaxonomy code 103TC1900X

License

6301013473 Issued in MI

Practice address

3011 W Grand Blvd Ste 413
Detroit, MI 48202-3011

Phone

(586) 257-2295

NPI assigned

Jul 11, 2008

Last updated

Oct 13, 2020By 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 MI

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

Clinical Psychologist

Education

Other, 2006

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

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.

• Crystal a. Jackson, PH.D. , LLP, LLC

  • Psychologist
  • Detroit, MI
  • NPI 1073124772
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1215734400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1602547200000",
    "number": "1255595948",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "212 WOODVIEW CT",
            "city": "ROCHESTER HILLS",
            "state": "MI",
            "postal_code": "483074112",
            "telephone_number": "586-943-0563"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3011 W GRAND BLVD STE 413",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482023011",
            "telephone_number": "586-257-2295"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "CRYSTAL",
        "middle_name": "A.",
        "name_prefix": "Dr.",
        "credential": "PH.D., LLP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2008-07-11",
        "last_updated": "2020-10-13",
        "certification_date": "2020-10-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC1900X",
            "taxonomy_group": "",
            "desc": "Psychologist, Counseling",
            "state": "MI",
            "license": "6301013473",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Charlyn Jackson
• Cheryl Jackson, CNP
• Cheryl Ann Jackson, LMSW, CAADC, CCS
• Christine Jackson, LMSW
• Cornell Lee Jackson
• Cynthia Linnea Jackson, LM, CPM
• Dairrus M Jackson
• Daleda Jackson
• Deandra B Jackson
• Debbie Jackson, LPN

• Counseling Psychologist in Detroit, MI
• Providers in Detroit, MI by specialty
• Counseling Psychologist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 13, 2020; 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.