Christopher Ladd Jackson, MC, LPC, LISAC, NCGC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

LPC-12267 Issued in AZ

Practice address

12301 W Bell Rd Ste A102
Surprise, AZ 85374-9707

Phone

(602) 614-5926

Fax

(623) 583-3888

NPI assigned

Dec 10, 2007

Sex

Male

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

Enrolled in AZ

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, 2003

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

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

{
    "created_epoch": "1197244800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1234396800000",
    "number": "1295918530",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 7164",
            "city": "SURPRISE",
            "state": "AZ",
            "postal_code": "85374",
            "telephone_number": "602-614-5926",
            "fax_number": "623-583-3888"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12301 W BELL RD STE A102",
            "city": "SURPRISE",
            "state": "AZ",
            "postal_code": "853749707",
            "telephone_number": "602-614-5926",
            "fax_number": "623-583-3888"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "CHRISTOPHER",
        "middle_name": "LADD",
        "name_prefix": "Mr.",
        "credential": "MC, LPC, LISAC, NCGC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-12-10",
        "last_updated": "2009-02-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "AZ",
            "license": "LISAC-11483",
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "AZ",
            "license": "LPC-12267",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ivy Lane Assisted Living,LLC
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• Michael Iyamu, D.O
• Izogn Group LLC
• Alina Hussein Jaafar, DMD
• Jeremiah Rashad Jackson
• Kristin Jackson, EDS
• Melissa Jeree Jackson, LPC
• Ryne Jackson, DMD, MSD
• Hannah Jacobs, DOT

• Professional Counselor in Surprise, AZ
• Providers in Surprise, AZ by specialty
• Professional Counselor in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 12, 2009; 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.