Corby Ryan Jackson

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

95036 Issued in TX

Practice address

11300 N Central Expy Ste 400
Dallas, TX 75243-6712

Phone

(844) 824-8775

Fax

(281) 648-2200

NPI assigned

Mar 10, 2016

Last updated

Sep 10, 2024By 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 2

Addresses

Medicare fee-for-service enrollment

Enrolled in IL

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.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Iatreia Mental Health SC

  • Psychiatry Physician
  • Joliet, IL
  • NPI 1144972860
  Medicare reassignment NPD
• Reflexive Truths PLLC

  • Professional Counselor
  • Dallas, TX
  • NPI 1184436628
  NPD Authorized official
• Iatreia Mental Health SC

  • Substance Abuse Rehabilitation Facility
  • Joliet, IL
  • NPI 1740975200
  NPD
• Grand Prairie Services

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Park Forest, IL
  • NPI 1417132093
  NPD (past)
• Grand Prairie Services

  • Federally Qualified Health Center (FQHC)
  • Chicago Heights, IL
  • NPI 1447723564
  NPD (past)

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

{
    "created_epoch": "1457568000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1725926400000",
    "number": "1639530215",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1225 RICHARDS ST",
            "city": "JOLIET",
            "state": "IL",
            "postal_code": "604332745",
            "telephone_number": "708-768-2144"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11300 N CENTRAL EXPY STE 400",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752436712",
            "telephone_number": "844-824-8775",
            "fax_number": "281-648-2200"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2319 Manhattan Rd",
            "address_purpose": "LOCATION",
            "city": "Joliet",
            "state": "IL",
            "postal_code": "604338605",
            "country_code": "US",
            "telephone_number": "815-314-0533",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1225 Richards St",
            "address_purpose": "LOCATION",
            "city": "Joliet",
            "state": "IL",
            "postal_code": "604332745",
            "country_code": "US",
            "telephone_number": "708-768-2144",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "CORBY",
        "middle_name": "RYAN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-03-10",
        "last_updated": "2024-09-10",
        "certification_date": "2024-09-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "IL",
            "license": "180.015589",
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "TX",
            "license": "95036",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Chayse Jackson, PA-C
• Chelsea Jackson
• Cheryl Ann Jackson
• Christine Jackson, MCD
• Clayton Jackson, MD
• Dan P Jackson, PT
• Daniel Jackson
• Danielle Jackson, PHD
• Daphne Jackson, LCSW
• David Everett Jackson, MD

• Professional Counselor in Dallas, TX
• Providers in Dallas, TX by specialty
• Professional Counselor in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 10, 2024; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.