Shelby Renee Jackson

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

Practice address

1836 Victoria LN
Charleston, IL 61920-2964

Phone

(217) 508-8080

Fax

(217) 512-2288

NPI assigned

Jun 9, 2022

Sex

Female

Sole proprietor

No

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 and National Provider Directory roles.

• Neuro Harmony PLLC

  • Professional Counselor
  • Charleston, IL
  • NPI 1467885616
  NPD

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

{
    "created_epoch": "1654732800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1655078400000",
    "number": "1285363614",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1836 VICTORIA LN",
            "city": "CHARLESTON",
            "state": "IL",
            "postal_code": "619202964",
            "telephone_number": "217-508-8080",
            "fax_number": "217-512-2288"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1836 VICTORIA LN",
            "city": "CHARLESTON",
            "state": "IL",
            "postal_code": "619202964",
            "telephone_number": "217-508-8080",
            "fax_number": "217-512-2288"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "SHELBY",
        "middle_name": "RENEE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-06-09",
        "last_updated": "2022-06-13",
        "certification_date": "2022-06-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jonathan A Hutti, D.C.
• Mark E Hutti, D.C.
• Stephen L Hutti, D.C.
• Timothy Patrick Hutti, D.C.
• Lisa Ingrum
• Valerie Jackson, APNP
• James M Kohlmann MD SC
• Jason B Jerabek, DO
• Emma Johnson, LSW
• Journey Professional Counseling LLC

• Mental Health Counselor in Charleston, IL
• Providers in Charleston, IL by specialty
• Mental Health Counselor in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 13, 2022; 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.