Anderson Cherokee Community Enrichment Services
Organization Active NPI Mental Health Clinic/Center (Including Community Mental Health Center) · Jacksonville, TX
NPI 1710015201 · NPPES record last updated Jun 12, 2024
Key facts
- NPI
- 1710015201
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X
- Legal business name
- ANDERSON CHEROKEE COMMUNITY ENRICHMENT SERVICES
- Practice address
- 1011 College Ave
Jacksonville, TX 75766 - Phone
- (903) 589-9000
- NPI assigned
- Feb 28, 2007
- Organization subpart
- No
Authorized official
- Name
- Dianna Strom
- Title
- Reimbursement Coordinator
- Phone
- (903) 589-9000
Other NPIs on the same Medicare enrollment 1
Practitioners 28
-
Donna Lee Faulkner, LPC
-
Emily Gross, LPC
-
Elnora King, NURSE PRACTITIONER
-
David Joel Korman, M.D.
-
Erick R. Lenert, PH.D.
-
Johnes Bogonko Monyoncho, DNP, PMHNP-BC
-
Adalid Sis, LPC
-
Marie Wynn, APRN
-
Kari D Herman, APRN, PMHNP, CNM
-
Iesha Jones, BSW LSW
-
Grace Kang, DO
-
Meghna N. Joshi, M.D.
-
Roxanne D. Dudley, RN, PMHNP-BC, LPC
-
Jon Guidry, MD
-
Mabel N. Nwachukwu, PMHNP
-
Alicia Vasquez, PMHNP-BC
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in TX
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20080229000537 | TX | Part B Supplier - Clinic/Group Practice | 4284718107 |
Receives reassigned benefits from 19 practitioners 1 other NPI on this enrollment Practice locations: Palestine, TX; Jacksonville, TX |
National Provider Directory
Locations
1011 College Ave
Ste Mhm
Jacksonville, TX 75766
1011 College Ave
Ste Mhr
Jacksonville, TX 75766
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Counselor |
101Y00000X | 17029 | TX | |
| Mental Health Counselor |
101YM0800X | 63332 | TX | |
| Professional Counselor |
101YP2500X | |||
| Psychologist |
103T00000X | |||
| Community Health Registered Nurse |
163WC1500X | 674004 | TX | |
| Community Health Registered Nurse |
163WC1500X | 618031 | TX | |
| Licensed Vocational Nurse |
164X00000X | 051913 | TX | |
| Psychiatry Physician |
2084P0800X | H5197 | TX | |
| Psychiatry Physician |
2084P0800X | K2150 | TX | |
| Mental Health Clinic/Center (Including Community Mental Health Center) | 261QM0801X | Yes | ||
| Substance Use Disorder Rehabilitation Clinic/Center | 261QR0405X | |||
| Physician Assistant |
363A00000X | |||
| Family Nurse Practitioner |
363LF0000X | |||
| Psychiatric/Mental Health Nurse Practitioner |
363LP0808X |
Addresses
Primary practice location
1011 College Ave
Jacksonville, TX 75766
Mailing address
1011 College Ave
Jacksonville, TX 75766-3307
Phone (903) 589-9000
Other practice location 1
3320 S Loop 256
Palestine, TX 75801-6984
Phone (903) 721-6136
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 111411803 | Medicaid | TX | |
| 00T09Z | Other | TX | BLUE CROSS BLUE SHIELD |
Other names
- ACCESS
Other providers in Jacksonville, TX
- Anderson Cherokee Community Enrichment Services
- Anderson Cherokee Community Enrichment Services
- Anderson Cherokee Community Enrichment Services
- Anderson Cherokee Community Enrichment Services
- Anderson Cherokee Community Enrichment Services
- Anderson Cherokee Community Enrichment Services
- Anderson Cherokee Community Enrichment Services
- Amanda Dawn Anderson
- John T Ardill
- Julian Avery Armstrong
All providers in Jacksonville, TX · Mental Health Clinic/Center (Including Community Mental Health Center) in Texas
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 12, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.