Crystal Rena Jackson, LPC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

015289 Issued in PA

Practice address

1015 Chestnut St Ste 1520
Philadelphia, PA 19107-4315

Phone

(215) 601-7379

NPI assigned

Dec 4, 2019

Last updated

Apr 19, 2023By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Enrolled in PA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Crystal R Jackson Healthy Lifestyle LLC

  • Professional Counselor
  • Jenkintown, PA
  • NPI 1518711829
  NPD Authorized official

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

{
    "created_epoch": "1575417600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1681862400000",
    "number": "1437796919",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1015 CHESTNUT ST STE 1520",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191074315",
            "telephone_number": "215-601-7379"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1015 CHESTNUT ST STE 1520",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191074315",
            "telephone_number": "215-601-7379"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "191 Presidential Blvd Ste W10",
            "address_purpose": "LOCATION",
            "city": "Bala Cynwyd",
            "state": "PA",
            "postal_code": "190041205",
            "country_code": "US",
            "telephone_number": "215-601-7379",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "CRYSTAL",
        "middle_name": "RENA",
        "credential": "LPC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-12-04",
        "last_updated": "2023-04-19",
        "certification_date": "2023-03-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "PA",
            "license": null,
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "PA",
            "license": "015289",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Chante L Jackson
• Cheri Lynn Jackson
• Cheryl A Jackson, M.D.
• Christina Jackson, M.D.
• Cody Boyer Jackson, MD, PHD
• Darryl Brett Jackson, M.D.
• Demeetra Jackson
• Donchelle Jackson
• Dvone Jackson, MD
• Elaine Jackson, LCPC

• Professional Counselor in Philadelphia, PA
• Providers in Philadelphia, PA by specialty
• Professional Counselor in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 19, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.