Active NPI
Kellie Jackson
- Mental Health Counselor
- Audubon, PA
National Provider Identifier
1447911565
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- Practice address
- 837 Mourning Dove Rd
Audubon, PA 19403-1820 - Phone
- (610) 716-6412
- NPI assigned
- Jan 2, 2022
- Last updated
- Jan 2, 2022
- 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
837 Mourning Dove Rd
Audubon, PA 19403-1820
Mailing address
846 W Lancaster Ave
Bryn Mawr, PA 19010-3224
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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1641081600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1641081600000",
"number": "1447911565",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "846 W LANCASTER AVE",
"city": "BRYN MAWR",
"state": "PA",
"postal_code": "190103224"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "837 MOURNING DOVE RD",
"city": "AUDUBON",
"state": "PA",
"postal_code": "194031820",
"telephone_number": "610-716-6412"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "KELLIE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2022-01-02",
"last_updated": "2022-01-02",
"certification_date": "2022-01-02",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Audubon, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 2, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.