Active NPI
Ian Jackson, LMHC
- Mental Health Counselor
- Fort Lauderdale, FL
National Provider Identifier
1356865943
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- 14930
- Practice address
- 915 Middle River Dr Ste 103C
Fort Lauderdale, FL 33304-3559 - Phone
- (908) 565-0866
- NPI assigned
- Jul 26, 2017
- Last updated
- Jul 26, 2017
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | 14930 | FL | Primary |
Addresses
Primary practice location
915 Middle River Dr Ste 103C
Fort Lauderdale, FL 33304-3559
Mailing address
9050 Jacaranda LN Apt 1
Plantation, FL 33324-3609
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 14930 | FL | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1501027200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1501027200000",
"number": "1356865943",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9050 JACARANDA LN APT 1",
"city": "PLANTATION",
"state": "FL",
"postal_code": "333243609"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "915 MIDDLE RIVER DR STE 103C",
"city": "FORT LAUDERDALE",
"state": "FL",
"postal_code": "333043559",
"telephone_number": "908-565-0866"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "IAN",
"name_prefix": "Mr.",
"credential": "LMHC",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2017-07-26",
"last_updated": "2017-07-26",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "FL",
"license": "14930",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fort Lauderdale, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 26, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.