Active NPI
Raquelle Jackson
- Professional Counselor
- Lancaster, TX
National Provider Identifier
1457123721
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 92372
- Practice address
- 1437 Brook Meadow Cir
Lancaster, TX 75134-2941 - Phone
- (940) 445-0616
- NPI assigned
- Oct 30, 2023
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | 92372 | TX | Primary |
Addresses
Primary practice location
1437 Brook Meadow Cir
Lancaster, TX 75134-2941
Mailing address
1437 Brook Meadow Cir
Lancaster, TX 75134-2941
Phone (940) 445-0616
Other names 1
- Raquelle Pegram
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 |
|---|---|---|---|
| 92372 | TX | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1698624000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1698624000000",
"number": "1457123721",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1437 BROOK MEADOW CIR",
"city": "LANCASTER",
"state": "TX",
"postal_code": "751342941",
"telephone_number": "940-445-0616"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1437 BROOK MEADOW CIR",
"city": "LANCASTER",
"state": "TX",
"postal_code": "751342941",
"telephone_number": "940-445-0616"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "RAQUELLE",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2023-10-30",
"last_updated": "2023-10-30",
"certification_date": "2023-10-30",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "TX",
"license": "92372",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "RAQUELLE",
"last_name": "PEGRAM",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Lancaster, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 30, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.