Crystal Jacks

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

Practice address

411 Court St
Portsmouth, OH 45662-3932

Phone

(740) 354-6685

NPI assigned

Aug 3, 2023

Sex

Female

Sole proprietor

Yes

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Interoperability endpoints

• Direct secure messaging: crystal.jacks.p1@direct.thecounselingcenter.nextgenshare.com

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

Specialties & licenses 2

Addresses

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Aug 3, 2023.

{
    "created_epoch": "1691020800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1691020800000",
    "number": "1669154142",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "411 COURT ST",
            "city": "PORTSMOUTH",
            "state": "OH",
            "postal_code": "456623932",
            "telephone_number": "740-354-6685",
            "fax_number": "740-876-4005"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "411 COURT ST",
            "city": "PORTSMOUTH",
            "state": "OH",
            "postal_code": "456623932",
            "telephone_number": "740-354-6685"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKS",
        "first_name": "CRYSTAL",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2023-08-03",
        "last_updated": "2023-08-03",
        "certification_date": "2023-08-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tessa Isaac
• Erika Nicole Isaacs, CRNA
• Jaclyn Ison
• Janell D. Ison, D.O.
• Sheridan Ison, LPN
• Amber Nicole Jackson
• Morgan Jackson, RN, CDCA
• Richard Jackson
• Adam S Jacobs, COTA
• Norman M Jacobs, MD

• All providers in Portsmouth, OH
• Addiction (Substance Use Disorder) Counselor in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 3, 2023; 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.