Kiaundra Jackson

Primary specialty

Marriage & Family TherapistTaxonomy code 106H00000X

License

100193 Issued in CA

Practice address

400 Continental Blvd FL 6
El Segundo, CA 90245-5074

Phone

(310) 751-0389

Fax

(310) 426-2001

NPI assigned

Sep 24, 2014

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not 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 and National Provider Directory roles.

• KW Couples Therapy, LLC

  • Adult Mental Health Clinic/Center
  • El Segundo, CA
  • NPI 1497277552
  NPD Authorized official

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

{
    "created_epoch": "1411516800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1521244800000",
    "number": "1275935983",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "400 CONTINENTAL BLVD, 6TH FLOOR",
            "city": "EL SEGUNDO",
            "state": "CA",
            "postal_code": "90245",
            "telephone_number": "310-751-0389"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 CONTINENTAL BLVD FL 6",
            "city": "EL SEGUNDO",
            "state": "CA",
            "postal_code": "902455074",
            "telephone_number": "310-751-0389",
            "fax_number": "310-426-2001"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1501 Hughes Way Ste 150",
            "address_purpose": "LOCATION",
            "city": "Long Beach",
            "state": "CA",
            "postal_code": "908101878",
            "country_code": "US",
            "telephone_number": "310-221-6336",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "KIAUNDRA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2014-09-24",
        "last_updated": "2018-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "CA",
            "license": "IMF82357",
            "primary": false
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "CA",
            "license": "100193",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Trinity Iverson
• Vanessa Jacinto
• Ashley Jackson
• Cleavona Jackson
• Diate Jackson
• Malia Jackson
• Matthew Jackson
• Rebecca Jackson
• Shaunice Jackson
• Abril Jacobo

• Marriage & Family Therapist in El Segundo, CA
• Providers in El Segundo, CA by specialty
• Marriage & Family Therapist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2018; 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.