Teri Lea Jackson

Primary specialty

Marriage & Family TherapistTaxonomy code 106H00000X

License

68899 Issued in CA

Practice address

555 Hospital LN
Susanville, CA 96130-4808

Phone

(530) 251-8108

NPI assigned

Sep 20, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

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

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.

• Shady Creek Therapy

  • Marriage & Family Therapist
  • Chester, CA
  • NPI 1710543483
  NPD (past) Authorized official

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

{
    "created_epoch": "1158710400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1426723200000",
    "number": "1700983509",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6219 STONEHEDGE DR",
            "city": "MARYSVILLE",
            "state": "CA",
            "postal_code": "959019519",
            "telephone_number": "530-713-8266"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "555 HOSPITAL LN",
            "city": "SUSANVILLE",
            "state": "CA",
            "postal_code": "961304808",
            "telephone_number": "530-251-8108"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "TERI",
        "middle_name": "LEA",
        "name_prefix": "Mrs.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-09-20",
        "last_updated": "2015-03-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "CA",
            "license": "68899",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BOARD OF BEHAVIORAL SCIENCES",
            "identifier": "68899",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Donna Carol Humphrey
• Dean Huynh
• Bonnie Marie Idso, MSCCCSLP
• Integrative Counseling Services
• Iron Pine Health a Nursing Professional Corporation
• James L. Snell PHD LMFT
• Glenn W James
• Jay M Beams MD Inc
• Jay M Beams MD,Inc
• Carolyn Johnson, LMFT

• Marriage & Family Therapist in Susanville, CA
• Providers in Susanville, CA by specialty
• Marriage & Family Therapist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 19, 2015; 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.