Active NPI
Ted Jackson
- Marriage & Family Therapist
- Corona, CA
National Provider Identifier
1487047072
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Marriage & Family Therapist
- License
- 102685
- Practice address
- 2275 S Main St Ste 201
Corona, CA 92882-5303 - Phone
- (951) 279-3222
- NPI assigned
- Mar 6, 2015
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | |||
| Marriage & Family Therapist | 106H00000X | 102685 | CA | Primary |
Addresses
Primary practice location
2275 S Main St Ste 201
Corona, CA 92882-5303
Mailing address
141 N Arrowhead Ave
San Bernardino, CA 92408
Phone (909) 963-5355
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": "1425600000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1509062400000",
"number": "1487047072",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "141 N ARROWHEAD AVE",
"city": "SAN BERNARDINO",
"state": "CA",
"postal_code": "92408",
"telephone_number": "909-963-5355"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2275 S MAIN ST STE 201",
"city": "CORONA",
"state": "CA",
"postal_code": "928825303",
"telephone_number": "951-279-3222"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "TED",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2015-03-06",
"last_updated": "2017-10-27",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": null,
"license": null,
"primary": false
},
{
"code": "106H00000X",
"taxonomy_group": "",
"desc": "Marriage & Family Therapist",
"state": "CA",
"license": "102685",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Corona, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 27, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.