Mary Jackson, LPC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

Practice address

1530 E Williams Field Rd Ste 201
Gilbert, AZ 85295-1825

Phone

(480) 561-6191

NPI assigned

Jun 1, 2018

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

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.

• Simplified Wellness PLLC

  • Mental Health Counselor
  • Gilbert, AZ
  • NPI 1639752330
  NPD Authorized official
• Wellqor Psychological Services, PC

  • Clinical Psychologist
  • Melville, NY
  • NPI 1063920841
  NPD

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

{
    "created_epoch": "1527811200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1619654400000",
    "number": "1508358813",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1530 E WILLIAMS FIELD RD STE 201",
            "city": "GILBERT",
            "state": "AZ",
            "postal_code": "852951825",
            "telephone_number": "480-561-6191"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1530 E WILLIAMS FIELD RD STE 201",
            "city": "GILBERT",
            "state": "AZ",
            "postal_code": "852951825",
            "telephone_number": "480-561-6191"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "MARY",
        "credential": "LPC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-06-01",
        "last_updated": "2021-04-29",
        "certification_date": "2021-04-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Erin Marie Jackson, FNP-C
• Jacquelyn Lee Jackson, RN
• Jennica Jackson
• Lauryn Jackson, PA-C
• Macheri Jackson
• Sally Fayrweather Jackson, HRN
• Starnique Antrenae Jackson
• Tahji Jackson
• Beth Louise Jaco, CPNP
• Jacob Zuniga,DDS,LLC

• Mental Health Counselor in Gilbert, AZ
• Providers in Gilbert, AZ by specialty
• Mental Health Counselor in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 29, 2021; 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.