Colleen Maguire Jackson, PH.D.

Primary specialty

Counseling PsychologistTaxonomy code 103TC1900X

License

20042613A Issued in IN

Practice address

703 3Rd St
West Lafayette, IN 47907-2081

Phone

(765) 494-6995

NPI assigned

Oct 3, 2013

Last updated

Apr 28, 2015By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Credentials

Doctor of Philosophy

State licenses

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

{
    "created_epoch": "1380758400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1430179200000",
    "number": "1417384504",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "703 3RD ST",
            "city": "WEST LAFAYETTE",
            "state": "IN",
            "postal_code": "479072081",
            "telephone_number": "765-494-6995"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "703 3RD ST",
            "city": "WEST LAFAYETTE",
            "state": "IN",
            "postal_code": "479072081",
            "telephone_number": "765-494-6995"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MAGUIRE JACKSON",
        "first_name": "COLLEEN",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2013-10-03",
        "last_updated": "2015-04-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "IN",
            "license": "20042613A",
            "primary": false
        },
        {
            "code": "103TC1900X",
            "taxonomy_group": "",
            "desc": "Psychologist, Counseling",
            "state": "IN",
            "license": "20042613A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kristen Nicole Lyons
• Michael Andrew Lyznicki
• Imogen Qinqing Ma
• Martin J Maassen, M.D.
• Gerald N Maesaka, M.D.
• Rutu R Mahajan, MD
• Megan Mahoney, LCSW
• Ryelee Elise Mains
• Herve Malan, PHARMD
• Brittany Lynn Maloney, D.O.

• Counseling Psychologist in West Lafayette, IN
• Providers in West Lafayette, IN by specialty
• Counseling Psychologist in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 28, 2015; 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.