Melanie Hope Jackson, PHD, LLC

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

1369 Issued in AL

Practice address

2864 Dauphin St
Suite a
Mobile, AL 36606-2479

Phone

(251) 259-8573

Fax

(251) 470-7609

NPI assigned

Dec 20, 2005

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

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Opted out of Medicare

Yes, effective Apr 1, 2015 through Apr 1, 2027

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

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 and National Provider Directory roles.

• Sage Moye LPC LLC

  • Professional Counselor
  • Mobile, AL
  • NPI 1891448627
  NPD (past)
• Susie Boucher LLC

  • Mental Health Counselor
  • Mobile, AL
  • NPI 1780343731
  NPD (past)

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

{
    "created_epoch": "1135036800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1201651200000",
    "number": "1619953726",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2864 DAUPHIN ST",
            "address_2": "SUITE A",
            "city": "MOBILE",
            "state": "AL",
            "postal_code": "366062479",
            "telephone_number": "251-259-8573",
            "fax_number": "251-470-7609"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2864 DAUPHIN ST",
            "address_2": "SUITE A",
            "city": "MOBILE",
            "state": "AL",
            "postal_code": "366062479",
            "telephone_number": "251-259-8573",
            "fax_number": "251-470-7609"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "MELANIE",
        "middle_name": "HOPE",
        "name_prefix": "Dr.",
        "credential": "PHD, LLC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-12-20",
        "last_updated": "2008-01-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "AL",
            "license": "1369",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GROUP MEDICARE",
            "identifier": "H398",
            "state": "AL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jennifer McCall Jackson, PSY.D.
• Julia Steele Jackson, PA-C
• Julianne Griffin Jackson, LPC
• Madison Jackson
• Maggie Cayson Jackson
• Michael Jackson Jr.
• Michelle S. Jackson, M.D.
• Regina Jackson
• Savannah Rommel Jackson, MS, LCPC, ALC
• Sharcarus Jackson

• Clinical Psychologist in Mobile, AL
• Providers in Mobile, AL by specialty
• Clinical Psychologist in Alabama

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 30, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.