Active NPI
Linda Johnson Jackson, PH.D.
- Clinical Psychologist
- Stafford, TX
National Provider Identifier
1487742102
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 2873
- Practice address
- 10701 Corporate Dr Ste 220
Stafford, TX 77477-4093 - Phone
- (713) 780-7333
- Fax
- (281) 242-4334
- NPI assigned
- Oct 10, 2006
- 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 |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 2873 | TX | Primary |
Addresses
Primary practice location
10701 Corporate Dr Ste 220
Stafford, TX 77477-4093
Mailing address
10701 Corporate Dr Ste 220
Stafford, TX 77477-4093
Phone (713) 780-7333
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in TX
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20101222000529 | TX | Practitioner - Clinical Psychologist | 1052509775 | Practice locations: Missouri City, TX |
Care Compare profile
Medicare Care Compare- Specialty
- Clinical Psychologist
- Education
- Other, 1983
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
Practice addresses (Care Compare)
4501 Cartwright Rd
Suite 103
Missouri City, TX 77459-3537
Phone (713) 780-7333
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2873 | TX | MD | Clinical Psychologist |
| 22873 | TX | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1160438400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1289952000000",
"number": "1487742102",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "10701 CORPORATE DR STE 220",
"city": "STAFFORD",
"state": "TX",
"postal_code": "774774093",
"telephone_number": "713-780-7333",
"fax_number": "281-242-4334"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "10701 CORPORATE DR STE 220",
"city": "STAFFORD",
"state": "TX",
"postal_code": "774774093",
"telephone_number": "713-780-7333",
"fax_number": "281-242-4334"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "LINDA",
"middle_name": "JOHNSON",
"credential": "PH.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-10-10",
"last_updated": "2010-11-17",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "TX",
"license": "2873",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Stafford, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 17, 2010; 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.