Melissa Faye Jackson, PH.D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

12-19P Issued in AR

Practice address

2024 Arkansas Valley Dr
Ste 206
Little Rock, AR 72212-4166

Phone

(501) 246-7171

Fax

(501) 246-7171

NPI assigned

Oct 12, 2006

Sex

Female

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

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.

• Lighthouse Professional Clinics Inc

  • Community/Behavioral Health Agency
  • Little Rock, AR
  • NPI 1144651050
  NPD (past) Authorized official
• Jackson Consulting LLC

  • Community/Behavioral Health Agency
  • Birmingham, AL
  • NPI 1033448824
  NPD (past) Authorized official
• The Village Consultant, LLC

  • Community/Behavioral Health Agency
  • MC Calla, AL
  • NPI 1871800490
  NPD (past) Authorized official
• Thriveworks Telepsychiatry - Arkansas

  • Mental Health Counselor
  • Fayetteville, AR
  • NPI 1669130928
  NPD

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

{
    "created_epoch": "1160611200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1398988800000",
    "number": "1619066982",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "75 RIVERFRONT DR",
            "address_2": "438",
            "city": "NORTH LITTLE ROCK",
            "state": "AR",
            "postal_code": "721145948",
            "telephone_number": "205-565-1694"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2024 ARKANSAS VALLEY DR",
            "address_2": "STE 206",
            "city": "LITTLE ROCK",
            "state": "AR",
            "postal_code": "722124166",
            "telephone_number": "501-246-7171",
            "fax_number": "501-246-7171"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "MELISSA",
        "middle_name": "FAYE",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-10-12",
        "last_updated": "2014-05-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "AR",
            "license": "12-19P",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Latoya Jackson
• Letoree Ceon Jackson, BSW
• Lindsey Roe Jackson, OTR
• Madysen Alaya Jackson, PLMSW
• Melainie Leann Jackson
• Ontaria Jackson
• Patsy L Jackson, MHPP
• Raven Jackson
• Salem Marie Jackson
• Shakeyah Jackson

• Clinical Psychologist in Little Rock, AR
• Providers in Little Rock, AR by specialty
• Clinical Psychologist in Arkansas

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

Verify at the official NPI Registry.