Bruce E Jackson, MA

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

LH00011181 Issued in WA

Practice address

6625 Wagner Way Ste 320
Gig Harbor, WA 98335-8392

Phone

(253) 858-7056

Fax

(253) 858-8028

NPI assigned

Jan 23, 2007

Last updated

Apr 13, 2021By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Feb 15, 2024 through Feb 15, 2028

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Arts

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Summit Health Management PLLC

  • Professional Counselor
  • Gig Harbor, WA
  • NPI 1508467564
  NPD (past)

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

{
    "created_epoch": "1169510400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1618272000000",
    "number": "1598819567",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6625 WAGNER WAY STE 320",
            "city": "GIG HARBOR",
            "state": "WA",
            "postal_code": "983358392",
            "telephone_number": "253-858-7056",
            "fax_number": "253-858-8028"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6625 WAGNER WAY STE 320",
            "city": "GIG HARBOR",
            "state": "WA",
            "postal_code": "983358392",
            "telephone_number": "253-858-7056",
            "fax_number": "253-858-8028"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "19910 Viking Ave NW Ste 103",
            "address_purpose": "LOCATION",
            "city": "Poulsbo",
            "state": "WA",
            "postal_code": "983707145",
            "country_code": "US",
            "telephone_number": "360-979-9970",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "BRUCE",
        "middle_name": "E",
        "credential": "MA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-01-23",
        "last_updated": "2021-04-13",
        "certification_date": "2021-04-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "WA",
            "license": "LH00011181",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Leah J Inman, D.O.
• Integrative Therapeutic Solutions, LLC (Certified Aging in Place Occupational Therapy)
• Denise Marie Iversen, O.D.
• Suzette Widdison Iverson, MPH PAC
• Adam S. Jackson, L.AC.
• James Allen Jackson, M.S.W.
• Trina Jackson, RBT
• Trisa Jackson, IHP
• Annaliese Jacobsson, LICSW, MSW, BSW
• Jennifer Nadine Jaggi, MD

• Mental Health Counselor in Gig Harbor, WA
• Providers in Gig Harbor, WA by specialty
• Mental Health Counselor in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 13, 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; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.