Active NPI
Erica Mack-Jackson
- Marriage & Family Therapist
- Indianapolis, IN
National Provider Identifier
1427516699
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Marriage & Family Therapist
- License
- 99091162A
- Practice address
- 4954 E 56TH St
Indianapolis, IN 46220-5773 - Phone
- (317) 500-4266
- NPI assigned
- Mar 6, 2019
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Social Worker | 104100000X | IN | ||
| Marriage & Family Therapist | 106H00000X | 99091162A | IN | Primary |
Addresses
Primary practice location
4954 E 56TH St
Indianapolis, IN 46220-5773
Mailing address
9110 Electric CT
Indianapolis, IN 46260-6104
Phone (317) 960-2770
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 |
|---|---|---|---|
| 99091162A | IN | MD | Marriage & Family Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1551830400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1732492800000",
"number": "1427516699",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9110 ELECTRIC CT",
"city": "INDIANAPOLIS",
"state": "IN",
"postal_code": "462606104",
"telephone_number": "317-960-2770"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4954 E 56TH ST",
"city": "INDIANAPOLIS",
"state": "IN",
"postal_code": "462205773",
"telephone_number": "317-500-4266"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MACK-JACKSON",
"first_name": "ERICA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2019-03-06",
"last_updated": "2024-11-25",
"certification_date": "2024-11-22",
"status": "A"
},
"taxonomies": [
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "IN",
"license": null,
"primary": false
},
{
"code": "106H00000X",
"taxonomy_group": "",
"desc": "Marriage & Family Therapist",
"state": "IN",
"license": "99091162A",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Indianapolis, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 25, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.