William Spencer Jackson, PHD

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

PY0264 Issued in NV

Practice address

880 W 12TH St
Reno, NV 89503-2601

Phone

(775) 982-5318

NPI assigned

Feb 14, 2007

Sex

Male

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Enrolled in NV

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.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

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.

• State of Nevada

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Ely, NV
  • NPI 1760572010
  Medicare reassignment NPD
• State of Nevada

  • Skilled Nursing Facility
  • Boulder City, NV
  • NPI 1083612741
  NPD
• State of Nevada

  • Psychiatric Hospital
  • Sparks, NV
  • NPI 1972501021
  NPD

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

{
    "created_epoch": "1171411200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1289347200000",
    "number": "1366585226",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "880 W 12TH ST",
            "city": "RENO",
            "state": "NV",
            "postal_code": "895032601",
            "telephone_number": "775-746-1869"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "880 W 12TH ST",
            "city": "RENO",
            "state": "NV",
            "postal_code": "895032601",
            "telephone_number": "775-982-5318"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "WILLIAM",
        "middle_name": "SPENCER",
        "name_prefix": "Dr.",
        "credential": "PHD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-02-14",
        "last_updated": "2010-11-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "NV",
            "license": "LADC 00248-L",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "CA",
            "license": "13587",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "NV",
            "license": "PY0264",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Michael Vincent Jackson, MD
• Monisa Jackson
• Rose Denise Jackson
• Teresa Jackson
• Theta Jackson
• Jacob Blake, MD LTD.
• Crista A Jacobe-Mann, RPT
• Randall N Jacobe, RPT
• Darryl Anthony Jacobs
• Jeanette Jacobs

• Clinical Psychologist in Reno, NV
• Providers in Reno, NV by specialty
• Clinical Psychologist in Nevada

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 10, 2010; 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.