Theresia Rene Jackson, LMHC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

MI16018 Issued in FL

Practice address

6460 NW 67TH Ter
Ocala, FL 34482-2130

Phone

(352) 875-1179

NPI assigned

Oct 23, 2019

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in FL

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

Specialty

Mental Health Counselor

Education

Other, 2014

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

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.

• Uplift Behavioral Health PC

  • Adult Mental Health Clinic/Center
  • Bethesda, MD
  • NPI 1629740410

  FL

  Medicare reassignment

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

{
    "created_epoch": "1571788800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1571788800000",
    "number": "1649813619",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6460 NW 67TH TER",
            "city": "OCALA",
            "state": "FL",
            "postal_code": "344822130",
            "telephone_number": "352-875-1179"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6460 NW 67TH TER",
            "city": "OCALA",
            "state": "FL",
            "postal_code": "344822130",
            "telephone_number": "352-875-1179"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "THERESIA",
        "middle_name": "RENE",
        "credential": "LMHC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-10-23",
        "last_updated": "2019-10-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "FL",
            "license": "MI16018",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "Ocala",
            "affiliation": "N",
            "address_1": "6460 NW 67th Ter",
            "city": "Ocala",
            "state": "FL",
            "country_code": "US",
            "postal_code": "344822130",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Kayla Shiann Jackson
• Melba J Jackson, PHD, MA
• Sabrina L Jackson
• Scott A. Jackson, DMD
• Shae Jackson
• Tracie Lee Jackson, RDN, LMNT, CDCES
• Sarah Jacobi-Wasserman
• Bobbi Jacobowitz, MA
• Jacqueline Marie Jacobowitz, LMHC
• Jamie Ann Jacobs, PA-C

• Mental Health Counselor in Ocala, FL
• Providers in Ocala, FL by specialty
• Mental Health Counselor in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 23, 2019; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.