Jackson Psychotherapy, LLC

Primary specialty

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

License

4352 Issued in KS

Legal business name

JACKSON PSYCHOTHERAPY, LLC

Practice address

901 Kentucky St Ste 306
Lawrence, KS 66044-2858

Phone

(816) 377-7398

Fax

(816) 873-1364

NPI assigned

Feb 22, 2018

Organization subpart

No

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

Authorized official

Name

Reginald C. Jackson, LSCSW, LCSW

Title

Owner/Psychotherapist

Phone

(816) 377-7398

Specialties & licenses 1

Addresses

Other identifiers 4

Tax ID family

Jackson Psychotherapy LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Jackson Psychotherapy, LLC

  dba The Satori Program

  • Clinical Social Worker
  • Lawrence, KS
  • NPI 1154846533
  NPD tax ID

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

{
    "created_epoch": "1519257600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1519257600000",
    "number": "1578064861",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "901 KENTUCKY ST STE 306",
            "city": "LAWRENCE",
            "state": "KS",
            "postal_code": "660442858",
            "telephone_number": "816-377-7398",
            "fax_number": "816-377-7398"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "901 KENTUCKY ST STE 306",
            "city": "LAWRENCE",
            "state": "KS",
            "postal_code": "660442858",
            "telephone_number": "816-377-7398",
            "fax_number": "816-873-1364"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JACKSON PSYCHOTHERAPY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-02-22",
        "last_updated": "2018-02-22",
        "status": "A",
        "authorized_official_last_name": "JACKSON",
        "authorized_official_first_name": "REGINALD",
        "authorized_official_middle_name": "C.",
        "authorized_official_title_or_position": "OWNER/PSYCHOTHERAPIST",
        "authorized_official_telephone_number": "816-377-7398",
        "authorized_official_credential": "LSCSW, LCSW"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": "KS",
            "license": "4352",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2015021883",
            "state": "MO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4352",
            "state": "KS"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS OF KANSAS CITY",
            "identifier": "2015021883",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "4352",
            "state": "KS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Iowa Street Dental Group, P.a. (Iowa Street Dental Group)
• Hong U. Ishaku
• Shelby Lynn Jack, M.S., CCC-SLP
• Rachel Leigh Jackson Meier, LIMHP, LMHP, LCPC
• Jackson Psychotherapy, LLC (The Satori Program)
• Heather Jackson, LPC
• Kaela Jackson, COTA/L
• Reginald Christopher Jackson, LSCSW
• Jacob Schmill Counseling LLC
• Ashlee Elizabeth Jacobson, RN

• Mental Health Clinic/Center (Including Community Mental Health Center) in Lawrence, KS
• Providers in Lawrence, KS by specialty
• Mental Health Clinic/Center (Including Community Mental Health Center) in Kansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 22, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.