Heather Leann Jackson, LPCC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

283493 Issued in KY

Practice address

Simmons Elementary Healthy Kids Clinic
830 Tyrone Pike
Versailles, KY 40383-1323

Phone

(844) 435-0900

Fax

(270) 858-4029

NPI assigned

Dec 4, 2015

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Cornerstone Therapy Solutions

  • Mental Health Counselor
  • Versailles, KY
  • NPI 1235831041

  Mental Health

  NPD Authorized official
• Cumberland Family Medical Center Inc

  • Federally Qualified Health Center (FQHC)
  • Versailles, KY
  • NPI 1407532765
  NPD

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

{
    "created_epoch": "1449187200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1704758400000",
    "number": "1679948491",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1080",
            "city": "BURKESVILLE",
            "state": "KY",
            "postal_code": "427171080",
            "telephone_number": "270-858-6655",
            "fax_number": "270-858-4027"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "SIMMONS ELEMENTARY HEALTHY KIDS CLINIC",
            "address_2": "830 TYRONE PIKE",
            "city": "VERSAILLES",
            "state": "KY",
            "postal_code": "403831323",
            "telephone_number": "844-435-0900",
            "fax_number": "270-858-4029"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "HEATHER",
        "middle_name": "LEANN",
        "credential": "LPCC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-12-04",
        "last_updated": "2024-01-09",
        "certification_date": "2023-05-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "KY",
            "license": "283493",
            "primary": true
        },
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "KY",
            "license": "169029",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1679948491",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Samantha Hutchinson, DC
• Ruth Lynn Irvin
• Isaiah House Inc
• Isaiah House Inc
• Lesley Carol Ison, SLP
• Nicole Jackson
• Bradley Jacobs
• Thamar Wilcie Janvier
• Megan M Jaspersen, MS
• Jennifer Jean Baptiste

• All providers in Versailles, KY
• Professional Counselor in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 9, 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.