Tonya Sue Jackson, PH.D.
Individual provider Active NPI Intellectual & Developmental Disabilities Psychologist · Alexandria, LA
NPI 1255657243 · NPPES record last updated Dec 14, 2021
Key facts
- NPI
- 1255657243
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Intellectual & Developmental Disabilities Psychologist 103TM1800X
- License
- 1072 (LA)
- Practice address
- 5411 Coliseum Blvd
Alexandria, LA 71303-3729 - Phone
- (318) 484-2347
- NPI assigned
- Apr 15, 2010
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in LA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20210806000488 | LA | Practitioner - Clinical Psychologist | 8628472081 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1072 | LA | MD | Addiction (Substance Use Disorder) Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Central la Human Services District | Current | Accepting new patients | |
| Central la Human Services District | Current |
Accepting new patients |
Locations
5411 Coliseum Blvd
Alexandria, LA 71303
Phone (318) 484-6850
2801 Fourth St
Ste 5
Jonesville, LA 71343
Phone (318) 339-8553
105 Belview Rd
Leesville, LA 71446
Phone (337) 238-6431
694 Government St
Marksville, LA 71351
Phone (318) 253-9638
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Intellectual & Developmental Disabilities Psychologist | 103TM1800X | 1072 | LA | Yes |
Addresses
Primary practice location
5411 Coliseum Blvd
Alexandria, LA 71303-3729
Mailing address
3770 Monroe Highway Ste C
PMB 170
Pineville, LA 71360-4170
Phone (318) 880-3044
Other providers in Alexandria, LA
- Ralph Dudley Jackson III
- Rita Jackson
- Ronnie Jackson
- Shadiamond Jackson
- Terrence Terrell Jackson
- Billyona Jacobs
- Felicia Yaquita Jacobs
- Naseem A Jaffrani
- James a. White, III, M.D., Apmc
- James P. David, M.D., a Professional Corporation
All providers in Alexandria, LA · Intellectual & Developmental Disabilities Psychologist in Louisiana
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 14, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.