Active NPI
Roger Dale Jackson, MA
- Mental Health Counselor
- Merrillville, IN
National Provider Identifier
1366957342
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- Practice address
- 8200 Georgia St
Merrillville, IN 46410-6227 - Phone
- (219) 791-1400
- Fax
- (219) 791-1422
- NPI assigned
- Dec 12, 2017
- Sex
- Male
- Sole proprietor
- No
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 | Primary |
Addresses
Primary practice location
8200 Georgia St
Merrillville, IN 46410-6227
Mailing address
3021 E 36TH Ave
Lake Station, IN 46405-2966
Phone (219) 743-6579
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
- Credentials
- Master of Arts
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Innovations in Learning, PC | Mental Health | Past | Accepting new patients |
Organizations & group practices 1
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": "1513036800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1539216000000",
"number": "1366957342",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3021 E 36TH AVE",
"city": "LAKE STATION",
"state": "IN",
"postal_code": "464052966",
"telephone_number": "219-743-6579"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "8200 GEORGIA ST",
"city": "MERRILLVILLE",
"state": "IN",
"postal_code": "464106227",
"telephone_number": "219-791-1400",
"fax_number": "219-791-1422"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "ROGER",
"middle_name": "DALE",
"credential": "MA",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2017-12-12",
"last_updated": "2018-10-11",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Merrillville, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 11, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.