Active NPI
Shirley Jackson, SOCIAL SERVICE WORK
- Mental Health Counselor
- Riverside, CA
National Provider Identifier
1396926499
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- Practice address
- 3625 14TH St
Riverside, CA 92501-3815 - Phone
- (951) 955-1582
- Fax
- (951) 955-1610
- NPI assigned
- Nov 16, 2007
- 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 |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | Primary |
Addresses
Primary practice location
3625 14TH St
Riverside, CA 92501-3815
Mailing address
PO Box 1405
Riverside, CA 92502-1405
Phone (951) 341-6440
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
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Public Guardian | Past | Accepting new patients | |
| Riverside County Dept of Mental Health | Past | Accepting new patients |
Organizations & group practices 2
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.
-
- Community/Behavioral Health Agency
- Riverside, CA
- NPI 1053776484
-
- Case Management Agency
- Riverside, CA
- NPI 1619159506
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1195171200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1597622400000",
"number": "1396926499",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 1405",
"city": "RIVERSIDE",
"state": "CA",
"postal_code": "925021405",
"telephone_number": "951-341-6440"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3625 14TH ST",
"city": "RIVERSIDE",
"state": "CA",
"postal_code": "925013815",
"telephone_number": "951-955-1582",
"fax_number": "951-955-1610"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "SHIRLEY",
"name_prefix": "Mrs.",
"credential": "SOCIAL SERVICE WORK",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-11-16",
"last_updated": "2020-08-17",
"certification_date": "2020-08-17",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Riverside, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 17, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.