Anthony N. Jackson, MA, LPCC, LCADC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

297949 Issued in KY

Practice address

6445 East Haven Way
Alvaton, KY 42122

Phone

(502) 509-6116

NPI assigned

May 15, 2019

Last updated

Oct 30, 2025By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other names 1

• Mr. Jack Jackson Other name

Medicare fee-for-service enrollment

Enrolled in KY

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

Specialty

Mental Health Counselor

Education

Other, 2022

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Lake Substance Abuse Solutions LLCGroup PAC ID 8123440401, 20 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Arts

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.

• Lake Substance Abuse Solutions LLC

  • Psychiatric/Mental Health Nurse Practitioner
  • Jeffersonville, IN
  • NPI 1124598669

  Addiction (Substance Use Disorder), KY

  Medicare reassignment Care Compare group NPD
• Casey Coursey LCSW Emdr

  • Group Psychotherapy Psychologist
  • Bowling Green, KY
  • NPI 1023763786
  NPD (past)

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

{
    "created_epoch": "1557878400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1761782400000",
    "number": "1487210399",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1143 FAIRWAY ST STE 103",
            "city": "BOWLING GREEN",
            "state": "KY",
            "postal_code": "421032452",
            "telephone_number": "407-347-4536"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6445 EAST HAVEN WAY",
            "city": "ALVATON",
            "state": "KY",
            "postal_code": "42122",
            "telephone_number": "502-509-6116"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1143 Fairway St Ste 103",
            "address_purpose": "LOCATION",
            "city": "Bowling Green",
            "state": "KY",
            "postal_code": "421032452",
            "country_code": "US",
            "telephone_number": "407-347-4539",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "ANTHONY",
        "middle_name": "N.",
        "name_prefix": "Mr.",
        "credential": "MA, LPCC, LCADC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-05-15",
        "last_updated": "2025-10-30",
        "certification_date": "2025-10-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "KY",
            "license": "297949",
            "primary": true
        },
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "KY",
            "license": "280595",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JACK",
            "last_name": "JACKSON",
            "prefix": "MR.",
            "credential": "MA, LPCC, LCADC",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Cassandra L Hanna, LCSW
• Melissa Beth Haselhoff, LCSW
• Aimee Hockman, LMFT
• Rachel L. Holton
• Lori Ann Humbert, LCSW
• Phillip A Kissinger, DMD
• Elizabeth Maynard
• Jonathan Bennett McNabb, MSPT
• Dennie Morrison Jr.
• Rebecca O'Bryan

• Professional Counselor in Alvaton, KY
• Providers in Alvaton, KY by specialty
• Professional Counselor in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 30, 2025; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.