Emily Nicole Jackson

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

MC61006566 Issued in WA

Practice address

16150 NE 85TH St Ste 120
Redmond, WA 98052-3542

Phone

(425) 868-5777

NPI assigned

Feb 2, 2021

Sex

Female

Sole proprietor

No

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

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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.

• Western Psychological and Counseling Services LLC

  • Clinical Psychologist
  • Tacoma, WA
  • NPI 1912008178

  Addiction (Substance Use Disorder)

  NPD (past)

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

{
    "created_epoch": "1612224000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1612224000000",
    "number": "1366033268",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8709 161ST AVE NE APT 208",
            "city": "REDMOND",
            "state": "WA",
            "postal_code": "980526660"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16150 NE 85TH ST STE 120",
            "city": "REDMOND",
            "state": "WA",
            "postal_code": "980523542",
            "telephone_number": "425-868-5777"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "EMILY",
        "middle_name": "NICOLE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-02-02",
        "last_updated": "2021-02-02",
        "certification_date": "2021-02-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "WA",
            "license": "CO60912147",
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "WA",
            "license": "MC61006566",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Irene Chasen DDS PLLC
• Aarzu Jawaid Isa, DO
• Isb.Inc
• Tomomi Ito, MA, LMHC, CDP
• Bella Mahamed Jabril
• Grant Charles Jacobs, DPT
• Brian Dean Jaeger, M.D.
• Ma Amairani Anahi Jaime Moreno
• Carol A Jakus
• James W Myers, PS

• Mental Health Counselor in Redmond, WA
• Providers in Redmond, WA by specialty
• Mental Health Counselor in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 2, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.