Active NPI
Jodene Packard, MA
- Counselor
- Flagstaff, AZ
National Provider Identifier
1316035959
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Counselor
- License
- LPC2508
- Practice address
- 1006 W Elizabeth Rd
Flagstaff, AZ 86001-1204 - Phone
- (928) 607-8495
- Fax
- (928) 213-9740
- NPI assigned
- Oct 10, 2006
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Counselor | 101Y00000X | LPC2508 | AZ | Primary |
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | LISAC 1466 | AZ |
Addresses
Primary practice location
1006 W Elizabeth Rd
Flagstaff, AZ 86001-1204
Mailing address
1006 W Elizabeth Rd
Flagstaff, AZ 86001-1204
Phone (928) 607-8495
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Arts
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LPC2508 | AZ | MD | Counselor |
| LISAC 1466 | AZ | MD | Addiction (Substance Use Disorder) Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1160438400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1368576000000",
"number": "1316035959",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1006 W ELIZABETH RD",
"city": "FLAGSTAFF",
"state": "AZ",
"postal_code": "860011204",
"telephone_number": "928-607-8495",
"fax_number": "928-213-9740"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1006 W ELIZABETH RD",
"city": "FLAGSTAFF",
"state": "AZ",
"postal_code": "860011204",
"telephone_number": "928-607-8495",
"fax_number": "928-213-9740"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PACKARD",
"first_name": "JODENE",
"credential": "MA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-10-10",
"last_updated": "2013-05-15",
"status": "A"
},
"taxonomies": [
{
"code": "101Y00000X",
"taxonomy_group": "",
"desc": "Counselor",
"state": "AZ",
"license": "LPC2508",
"primary": true
},
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": "AZ",
"license": "LISAC 1466",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Flagstaff, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 15, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.