Jacqueline Nashelle Lockett, LISW

Primary specialty

Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X

License

I.2102892 Issued in OH

Practice address

35104 Euclid Ave Ste 306
Willoughby, OH 44094-4566

Phone

(216) 387-1759

Fax

(440) 571-5009

NPI assigned

Feb 16, 2018

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in OH

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

Medicare enrollment (NPD)

Enrolled

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 and National Provider Directory roles.

• Phoenix Counseling and Wellness, LLC

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Willoughby, OH
  • NPI 1154932473

  Clinical

  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1518739200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1666828800000",
    "number": "1497255343",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "35104 EUCLID AVE STE 306",
            "city": "WILLOUGHBY",
            "state": "OH",
            "postal_code": "440944566",
            "telephone_number": "440-571-5009",
            "fax_number": "440-571-4850"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "35104 EUCLID AVE STE 306",
            "city": "WILLOUGHBY",
            "state": "OH",
            "postal_code": "440944566",
            "telephone_number": "216-387-1759",
            "fax_number": "440-571-5009"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LOCKETT",
        "first_name": "JACQUELINE",
        "middle_name": "NASHELLE",
        "name_prefix": "Ms.",
        "credential": "LISW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-02-16",
        "last_updated": "2022-10-27",
        "certification_date": "2022-10-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "OH",
            "license": "S.1302602",
            "primary": false
        },
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": "OH",
            "license": "I.2102892",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0268275",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Liv Consulting and Services LLC
• Liv Management
• Amy Marie Livingston, ANP
• George Livingston, PA
• Emily Lloyd
• Jonathan Scott Logan, DPM
• Devin Long
• Joanne T Longbons, PA-C
• Casey Nicole Loomis
• Jennifer J.R. Loomis, AA-C

• Mental Health Clinic/Center (Including Community Mental Health Center) in Willoughby, OH
• Providers in Willoughby, OH by specialty
• Mental Health Clinic/Center (Including Community Mental Health Center) in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 27, 2022; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.