Jeffrey Jack, MA, LPCC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

Practice address

2801 Martin Luther King Jr Dr
Cleveland, OH 44104

Phone

(216) 448-6325

NPI assigned

Dec 1, 2017

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

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Arts

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.

• Concord Therapy Solutions LLC

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Concord Township, OH
  • NPI 1932965969
  NPD Authorized official
• The Cleveland Clinic Foundation

  • General Acute Care Hospital
  • Cleveland, OH
  • NPI 1679525919
  NPD

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

{
    "created_epoch": "1512086400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1648512000000",
    "number": "1346754124",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2801 MARTIN LUTHER KING JR DR",
            "city": "CLEVELAND",
            "state": "OH",
            "postal_code": "441043815",
            "telephone_number": "216-448-6325"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2801 MARTIN LUTHER KING JR DR",
            "city": "CLEVELAND",
            "state": "OH",
            "postal_code": "44104",
            "telephone_number": "216-448-6325"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3929 Rocky River Dr",
            "address_purpose": "LOCATION",
            "city": "Cleveland",
            "state": "OH",
            "postal_code": "441114153",
            "country_code": "US",
            "telephone_number": "216-252-5800",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2801 Martin Luther King Jr Dr",
            "address_purpose": "LOCATION",
            "city": "Cleveland",
            "state": "OH",
            "postal_code": "44104",
            "country_code": "US",
            "telephone_number": "216-448-6325",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JACK",
        "first_name": "JEFFREY",
        "credential": "MA, LPCC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2017-12-01",
        "last_updated": "2022-03-29",
        "certification_date": "2022-03-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "171M00000X",
            "taxonomy_group": "",
            "desc": "Case Manager/Care Coordinator",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Wael A Jaber, MD
• Megan Jablonski
• Raymond Francis Jabola, DO
• Anwar Jabour, DDS
• Anne Therese Jack, PT
• Megan M Jack, M.D, PH.D.
• Christopher Jackman, APRN
• Sara Jackman
• Leonard Joseph Jacko Jr., D.D.S.
• Zakiya R Jackson Boyd

• Mental Health Counselor in Cleveland, OH
• Providers in Cleveland, OH by specialty
• Mental Health Counselor in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 29, 2022; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.