Marilyn Renee Jackson, LPC-S

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

63045 Issued in TX

Practice address

915 Brookmere Dr
Dallas, TX 75216-6128

Phone

(972) 502-6660

NPI assigned

May 1, 2007

Sex

Female

Sole proprietor

Yes

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 TX

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

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.

• Permanent Resolutions

  • Professional Counselor
  • Duncanville, TX
  • NPI 1821231622
  NPD (past) Authorized official
• Dallas Independent School District

  • Local Education Agency (LEA)
  • Dallas, TX
  • NPI 1760522510

  Professional

  NPD (past)

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

{
    "created_epoch": "1177977600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1725580800000",
    "number": "1669693453",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 381465",
            "city": "DUNCANVILLE",
            "state": "TX",
            "postal_code": "751381465",
            "telephone_number": "214-682-0432",
            "fax_number": "972-283-2024"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "915 BROOKMERE DR",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752166128",
            "telephone_number": "972-502-6660"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "419 W Wheatland Rd Ste 101",
            "address_purpose": "LOCATION",
            "city": "Duncanville",
            "state": "TX",
            "postal_code": "751164619",
            "country_code": "US",
            "telephone_number": "972-283-1050",
            "fax_number": "972-283-0352",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "MARILYN",
        "middle_name": "RENEE",
        "name_prefix": "Mrs.",
        "credential": "LPC-S",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-05-01",
        "last_updated": "2024-09-06",
        "certification_date": "2024-09-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "TX",
            "license": "201027",
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "TX",
            "license": "63045",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Linda Johnson Jackson, OD
• Lindsey Marie Jackson
• Lisa Jackson
• Marcus Jackson
• Maria O. Jackson, D.D.S.
• Mary Jackson
• Meredith Jackson, MD
• Morya Koquese Jackson
• Nancy Angelia Jackson, MS-CCC/SLP
• Nancy Jo Jackson, PA-C

• 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 6, 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.