Active NPI
Harry Lee Jackson
- Mental Health Counselor
- Victorville, CA
National Provider Identifier
1710467659
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- Practice address
- 17845 Ironwood Lane
Victorville, CA 92395-9239 - Phone
- (760) 373-6251
- NPI assigned
- Aug 20, 2018
- 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 |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | Primary |
Addresses
Primary practice location
17845 Ironwood Lane
Victorville, CA 92395-9239
Mailing address
17845 Ironwood Lane
SVL Box 8205
Victorville, CA 92395
Phone (562) 230-0737
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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1534723200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1534723200000",
"number": "1710467659",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "17845 IRONWOOD LANE",
"address_2": "SVL BOX 8205",
"city": "VICTORVILLE",
"state": "CA",
"postal_code": "92395",
"telephone_number": "562-230-0737"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "17845 IRONWOOD LANE",
"city": "VICTORVILLE",
"state": "CA",
"postal_code": "923959239",
"telephone_number": "760-373-6251"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "HARRY",
"middle_name": "LEE",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2018-08-20",
"last_updated": "2018-08-20",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Counselor, Mental Health",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Victorville, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 20, 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.