Active NPI
Lara Jeanne Jackson, LMFT
- Marriage & Family Therapist
- Vista, CA
National Provider Identifier
1669186490
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Marriage & Family Therapist
- License
- 136069
- Practice address
- 1611 S Melrose Dr
Ste a #280
Vista, CA 92081-7037 - Phone
- (760) 230-3451
- Fax
- (209) 659-6382
- NPI assigned
- Jan 6, 2023
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Marriage & Family Therapist | 106H00000X | 136069 | CA | Primary |
Addresses
Primary practice location
1611 S Melrose Dr
Ste a #280
Vista, CA 92081-7037
Mailing address
1611 S Melrose Dr
Ste a #280
Vista, CA 92081-7037
Phone (760) 230-3451
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 136069 | CA | MD | Marriage & Family Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1672963200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1739750400000",
"number": "1669186490",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1611 S MELROSE DR",
"address_2": "STE A #280",
"city": "VISTA",
"state": "CA",
"postal_code": "920817037",
"telephone_number": "760-230-3451"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1611 S MELROSE DR",
"address_2": "STE A #280",
"city": "VISTA",
"state": "CA",
"postal_code": "920817037",
"telephone_number": "760-230-3451",
"fax_number": "209-659-6382"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "LARA",
"middle_name": "JEANNE",
"credential": "LMFT",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2023-01-06",
"last_updated": "2025-02-17",
"certification_date": "2025-02-17",
"status": "A"
},
"taxonomies": [
{
"code": "106H00000X",
"taxonomy_group": "",
"desc": "Marriage & Family Therapist",
"state": "CA",
"license": "136069",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Vista, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 17, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.