Active NPI
Karen Jackson
- Mental Health Counselor
- West Bloomfield, MI
National Provider Identifier
1417402603
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- 6401015668
- Practice address
- 6564 Crescent GRN
West Bloomfield, MI 48322-1323 - Phone
- (313) 695-3469
- NPI assigned
- Aug 17, 2016
- Last updated
- Oct 5, 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 |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | 6401015668 | MI | Primary |
Addresses
Primary practice location
6564 Crescent GRN
West Bloomfield, MI 48322-1323
Mailing address
6564 Crescent GRN
West Bloomfield, MI 48322-1323
Phone (313) 695-3469
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6401015668 | MI | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1471392000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1475625600000",
"number": "1417402603",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6564 CRESCENT GRN",
"city": "WEST BLOOMFIELD",
"state": "MI",
"postal_code": "483221323",
"telephone_number": "313-695-3469"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6564 CRESCENT GRN",
"city": "WEST BLOOMFIELD",
"state": "MI",
"postal_code": "483221323",
"telephone_number": "313-695-3469"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "KAREN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2016-08-17",
"last_updated": "2016-10-05",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "MI",
"license": "6401015668",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in West Bloomfield, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 5, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.