Anthony N. Jackson, MA, LPCC, LCADC
Individual provider Active NPI Professional Counselor · Alvaton, KY
NPI 1487210399 · NPPES record last updated Oct 30, 2025
Key facts
- NPI
- 1487210399
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Professional Counselor 101YP2500X
- License
- 297949 (KY)
- Practice address
- 6445 East Haven Way
Alvaton, KY 42122 - Phone
- (502) 509-6116
- NPI assigned
- May 15, 2019
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 2
Medicare Care Compare profile
- Specialty
- Mental Health Counselor
- Education
- Other, 2022
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Lake Substance Abuse Solutions LLC
Practice addresses (Care Compare)
1143 Fairway St
Suite 103
Bowling Green, KY 42103-2452
Phone (833) 525-3727
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in KY
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20251118003781 | KY | Practitioner - Mental Health Counselor | 5991296832 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Master of Arts
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 280595 | KY | MD | Addiction (Substance Use Disorder) Counselor |
| 297949 | KY | MD | Professional Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Lake Substance Abuse Solutions LLC | Addiction (Substance Use Disorder) | Current |
Accepting new patients |
| Casey Coursey LCSW Emdr | Past | Accepting new patients |
Locations
225 W Canton Ave
Ste 600
Winter Park, FL 32789
Phone (407) 347-4536
1143 Fairway St
Ste 103
Bowling Green, KY 42103
Phone (812) 901-6881
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | 297949 | KY | Yes |
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | 280595 | KY |
Addresses
Primary practice location
6445 East Haven Way
Alvaton, KY 42122
Mailing address
1143 Fairway St Ste 103
Bowling Green, KY 42103-2452
Phone (407) 347-4536
Other practice location 1
1143 Fairway St Ste 103
Bowling Green, KY 42103-2452
Phone (407) 347-4539
Other names
- Mr. Jack Jackson
Other providers in Alvaton, KY
- Cassandra L Hanna
- Melissa Beth Haselhoff
- Aimee Hockman
- Rachel L. Holton
- Lori Ann Humbert
- Phillip A Kissinger
- Elizabeth Maynard
- Jonathan Bennett McNabb
- Dennie Morrison Jr.
- Rebecca O'Bryan
All providers in Alvaton, KY · Professional Counselor in Kentucky
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 30, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.