Active NPI
Alex Jackson
- Mental Health Counselor
- Ventura, CA
National Provider Identifier
1609279702
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- Practice address
- 1838 Eastman Ave Ste 100
Ventura, CA 93003-6498 - Phone
- (805) 665-7748
- NPI assigned
- Oct 2, 2014
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | Primary |
Addresses
Primary practice location
1838 Eastman Ave Ste 100
Ventura, CA 93003-6498
Mailing address
1838 Eastman Ave Ste 100
Ventura, CA 93003-6498
Phone (805) 665-7748
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 56CC | Other | CA | ASPIRA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1412208000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1412208000000",
"number": "1609279702",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1838 EASTMAN AVE STE 100",
"city": "VENTURA",
"state": "CA",
"postal_code": "930036498",
"telephone_number": "805-665-7748"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1838 EASTMAN AVE STE 100",
"city": "VENTURA",
"state": "CA",
"postal_code": "930036498",
"telephone_number": "805-665-7748"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "ALEX",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2014-10-02",
"last_updated": "2014-10-02",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ASPIRA",
"identifier": "56CC",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Ventura, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 2, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.