Active NPI
Alicia Jackson, M.A., C.M.H.S.
- Counselor
- Longview, WA
National Provider Identifier
1659622975
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Counselor
- License
- 60926696
- Practice address
- 720 14TH Ave.
Longview, WA 98632 - Phone
- (360) 423-0203
- Fax
- (360) 423-5086
- NPI assigned
- Sep 26, 2012
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Counselor | 101Y00000X | 60926696 | WA | Primary |
Addresses
Primary practice location
720 14TH Ave.
Longview, WA 98632
Mailing address
921 14TH Avenue
Longview, WA 98632
Phone (360) 423-0203
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2097719 | Medicaid | WA |
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
- Credentials
- Master of Arts
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 60926696 | WA | MD | Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1348617600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1551830400000",
"number": "1659622975",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "921 14TH AVENUE",
"city": "LONGVIEW",
"state": "WA",
"postal_code": "98632",
"telephone_number": "360-423-0203",
"fax_number": "360-577-0269"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "720 14TH AVE.",
"city": "LONGVIEW",
"state": "WA",
"postal_code": "98632",
"telephone_number": "360-423-0203",
"fax_number": "360-423-5086"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "ALICIA",
"credential": "M.A., C.M.H.S.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2012-09-26",
"last_updated": "2019-03-06",
"status": "A"
},
"taxonomies": [
{
"code": "101Y00000X",
"taxonomy_group": "",
"desc": "Counselor",
"state": "WA",
"license": "60926696",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "2097719",
"state": "WA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Longview, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 6, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.