Active NPI
Tam-Me Jackson
- Marriage & Family Therapist
- Stockton, CA
National Provider Identifier
1376093781
On this page
OIG exclusion record
The HHS Office of Inspector General’s List of Excluded Individuals/Entities (LEIE) contains a record with this NPI:
- Section 1128a(3) exclusion effective Oct 20, 2024.
Key facts
NPPES NPI Registry- Primary specialty
- Marriage & Family Therapist
- License
- 48768
- Practice address
- 5651 N Pershing Ave
C6
Stockton, CA 95207-4947 - Phone
- (209) 915-4212
- NPI assigned
- Oct 10, 2016
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Marriage & Family Therapist | 106H00000X | 48768 | CA | Primary |
Addresses
Primary practice location
5651 N Pershing Ave
C6
Stockton, CA 95207-4947
Mailing address
5651 N Pershing Ave
C6
Stockton, CA 95207-4947
Phone (209) 915-4212
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
- HHS exclusion list flag
- Flagged The directory lists this NPI on an HHS exclusion list.
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 48768 | CA | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1476057600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1476057600000",
"number": "1376093781",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5651 N PERSHING AVE",
"address_2": "C6",
"city": "STOCKTON",
"state": "CA",
"postal_code": "952074947",
"telephone_number": "209-915-4212"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5651 N PERSHING AVE",
"address_2": "C6",
"city": "STOCKTON",
"state": "CA",
"postal_code": "952074947",
"telephone_number": "209-915-4212"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "TAM-ME",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2016-10-10",
"last_updated": "2016-10-10",
"status": "A"
},
"taxonomies": [
{
"code": "106H00000X",
"taxonomy_group": "",
"desc": "Marriage & Family Therapist",
"state": "CA",
"license": "48768",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Stockton, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 10, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; OIG LEIE.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.