Active NPI
Tamickco Maria Deen Jackson, MENTAL HEALTH COUNSE
- Mental Health Counselor
- Pearl City, HI
National Provider Identifier
1669979738
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- MHC-418
- Practice address
- 941 Kamehameha Hwy Ste 204
Pearl City, HI 96782-2516 - Phone
- (808) 633-0405
- NPI assigned
- Apr 6, 2018
- 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 |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | MHC-418 | HI | Primary |
Addresses
Primary practice location
941 Kamehameha Hwy Ste 204
Pearl City, HI 96782-2516
Mailing address
PO Box 3171
Mililani, HI 96789
Phone (808) 633-0405
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 |
|---|---|---|---|
| MHC-418 | HI | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1522972800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1522972800000",
"number": "1669979738",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 3171",
"city": "MILILANI",
"state": "HI",
"postal_code": "96789",
"telephone_number": "808-633-0405"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "941 KAMEHAMEHA HWY STE 204",
"city": "PEARL CITY",
"state": "HI",
"postal_code": "967822516",
"telephone_number": "808-633-0405"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "TAMICKCO",
"middle_name": "MARIA DEEN",
"credential": "MENTAL HEALTH COUNSE",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2018-04-06",
"last_updated": "2018-04-06",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "HI",
"license": "MHC-418",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Pearl City, HI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 6, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.