Active NPI
Skye Daniel Jackson, M.A., LPC
- Professional Counselor
- Normal, IL
National Provider Identifier
1679964654
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 178010761
- Practice address
- 706 Oglesby Ave Ste 112
Normal, IL 61761-4618 - Phone
- (309) 585-0241
- NPI assigned
- Feb 11, 2015
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | 178010761 | IL | Primary |
Addresses
Primary practice location
706 Oglesby Ave Ste 112
Normal, IL 61761-4618
Mailing address
706 Oglesby Ave Ste 112
Normal, IL 61761-4618
Phone (309) 585-0241
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
- Credentials
- Master of Arts
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 178010761 | IL | MD | Professional Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Truth in Love Counseling LLC | Professional | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Professional Counselor
- Bloomington, IL
- NPI 1831526961
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1423612800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1423612800000",
"number": "1679964654",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "706 OGLESBY AVE STE 112",
"city": "NORMAL",
"state": "IL",
"postal_code": "617614618",
"telephone_number": "309-585-0241"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "706 OGLESBY AVE STE 112",
"city": "NORMAL",
"state": "IL",
"postal_code": "617614618",
"telephone_number": "309-585-0241"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "SKYE",
"middle_name": "DANIEL",
"name_prefix": "Mr.",
"credential": "M.A., LPC",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2015-02-11",
"last_updated": "2015-02-11",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "IL",
"license": "178010761",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Normal, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 11, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.