Andre Nakromba Jackson, MFTI

Primary specialty

Marriage & Family TherapistTaxonomy code 106H00000X

License

129229 Issued in CA

Practice address

17800 US Highway 18
Apple Valley, CA 92307-1221

Phone

(760) 552-6700

NPI assigned

Dec 1, 2015

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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

• Jackson Family Therapy LLC

  • Mental Health Counselor
  • Hesperia, CA
  • NPI 1043925266
  NPD Authorized official
• San Bernardino County Superintendent of Schools

  • Community/Behavioral Health Agency
  • Apple Valley, CA
  • NPI 1518091966
  NPD (past)

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

{
    "created_epoch": "1448928000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1637020800000",
    "number": "1477928562",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17800 US HIGHWAY 18",
            "city": "APPLE VALLEY",
            "state": "CA",
            "postal_code": "923071221",
            "telephone_number": "760-552-6700"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17800 US HIGHWAY 18",
            "city": "APPLE VALLEY",
            "state": "CA",
            "postal_code": "923071221",
            "telephone_number": "760-552-6700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "ANDRE",
        "middle_name": "NAKROMBA",
        "credential": "MFTI",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-12-01",
        "last_updated": "2021-11-16",
        "certification_date": "2021-11-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "CA",
            "license": "123981",
            "primary": false
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "CA",
            "license": "84202",
            "primary": false
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "CA",
            "license": "129229",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Cameron Ali Irshaid
• Kevork Iskenderian, M.D.
• Sergio Islas
• Shurouk I Ismail, MD
• Amanda Leigh Jackson
• Bruce L Jackson, P.A.
• Daysia Jackson
• Fredrick Jackson
• Jessica Jackson
• Terri Jackson, RN

• All providers in Apple Valley, CA
• Marriage & Family Therapist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 16, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.