Individual provider Active NPI

Cierra Shamar Jackson, M.A.

  • Mental Health Counselor
  • Minneapolis, MN
National Provider Identifier
1316499551
Registry record updated Sep 22, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
License
1366 Issued in MN
Practice address
2220 Plymouth Ave N
Minneapolis, MN 55411-3600
Phone
(612) 543-2561
NPI assigned
Nov 3, 2016
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 22, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X 1366 MN Primary

Addresses

Primary practice location

2220 Plymouth Ave N
Minneapolis, MN 55411-3600

Mailing address

2220 Plymouth Ave N
Minneapolis, MN 55411-3600
Phone (612) 543-2561

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN
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

Enrollment IDStateProvider typePAC IDDetails
I20251002000086 MN Practitioner - Mental Health Counselor 8729584362 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Mental Health Counselor
Education
Other, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Hennepin CountyGroup PAC ID 7911892849, 132 clinicians

Practice addresses (Care Compare)

1313 Penn N Ave
Minneapolis, MN 55411-3047
Phone (612) 543-2500

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Master of Arts

State licenses

LicenseStateTypeSpecialty
1366MNMDMarriage & Family Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Hennepin County CurrentSince Aug 22, 2025 Accepting new patients
Hennepin County Mental Health Current Accepting new patients
Hennepin County CurrentSince Aug 22, 2025 Accepting new patients

Locations

2220 Plymouth Ave N
Minneapolis, MN 55411
Phone (612) 543-2500

1313 Penn Ave N
Minneapolis, MN 55411
Phone (612) 302-4600

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1478131200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1758499200000",
    "number": "1316499551",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2220 PLYMOUTH AVE N",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554113600",
            "telephone_number": "612-543-2561"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2220 PLYMOUTH AVE N",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554113600",
            "telephone_number": "612-543-2561"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "CIERRA",
        "middle_name": "SHAMAR",
        "credential": "M.A.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-11-03",
        "last_updated": "2025-09-22",
        "certification_date": "2025-09-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "MN",
            "license": "1366",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Minneapolis, MN

Sources for this page

Verify at the official NPI Registry.